Provider Demographics
NPI:1932267622
Name:COTEY, JUDIE V (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDIE
Middle Name:V
Last Name:COTEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E WISCONSIN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3057
Mailing Address - Country:US
Mailing Address - Phone:262-567-6003
Mailing Address - Fax:262-567-6001
Practice Address - Street 1:175 E WISCONSIN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3057
Practice Address - Country:US
Practice Address - Phone:262-567-6003
Practice Address - Fax:262-567-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4774015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist