Healthcare Provider Details

I. General information

NPI: 1902260466
Provider Name (Legal Business Name): DR. JOHN COTTEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N CEDAR ST
FOLEY AL
36535-1473
US

IV. Provider business mailing address

4850 N 9TH AVE STE 4
PENSACOLA FL
32503-2406
US

V. Phone/Fax

Practice location:
  • Phone: 251-943-3381
  • Fax:
Mailing address:
  • Phone: 850-477-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3212
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: