Provider Demographics
NPI:1336766963
Name:KOTTER, NATE ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATE
Middle Name:ROBERT
Last Name:KOTTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4411
Mailing Address - Country:US
Mailing Address - Phone:218-213-2645
Mailing Address - Fax:
Practice Address - Street 1:1832 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1811
Practice Address - Country:US
Practice Address - Phone:218-722-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND143871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice