Provider Demographics
NPI:1265768113
Name:COTTONWOOD FAMILY DENTAL ASSOCIATES
Entity type:Organization
Organization Name:COTTONWOOD FAMILY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CLEO
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-234-8080
Mailing Address - Street 1:208 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5706
Mailing Address - Country:US
Mailing Address - Phone:972-234-8080
Mailing Address - Fax:972-644-2398
Practice Address - Street 1:208 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5706
Practice Address - Country:US
Practice Address - Phone:972-234-8080
Practice Address - Fax:972-644-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty