Provider Demographics
NPI:1811738016
Name:KOTTKE, AUSTIN JOHN (DDS)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JOHN
Last Name:KOTTKE
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 1:2428 DELAWARE ST SE APT 409
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3829
Mailing Address - Country:US
Mailing Address - Phone:952-688-2506
Mailing Address - Fax:
Practice Address - Street 1:1970 BUERKLE RD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-1300
Practice Address - Country:US
Practice Address - Phone:651-337-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist