Healthcare Provider Details

I. General information

NPI: 1295170603
Provider Name (Legal Business Name): DUSTY V COTTER D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 N TATUM BLVD STE 22 BANFIEL THE PET HOSPITAL AT DESERT RIDGE
PHOENIX AZ
85050-4208
US

IV. Provider business mailing address

22205 N 31ST DR
PHOENIX AZ
85027-1610
US

V. Phone/Fax

Practice location:
  • Phone: 480-419-4067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number3160
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: