Provider Demographics
NPI:1992030001
Name:COTTMON DENTAL GROUP
Entity Type:Organization
Organization Name:COTTMON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:610-639-3060
Mailing Address - Street 1:2901 SECANE DR
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1329
Mailing Address - Country:US
Mailing Address - Phone:215-632-1245
Mailing Address - Fax:215-632-8456
Practice Address - Street 1:2901 SECANE DR
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19154-1329
Practice Address - Country:US
Practice Address - Phone:215-632-1245
Practice Address - Fax:215-632-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty