Healthcare Provider Details

I. General information

NPI: 1013012228
Provider Name (Legal Business Name): KATHERINE TUDOR COTTON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10036 N BLUE CROSSING WAY
TUCSON AZ
85743-5211
US

IV. Provider business mailing address

10036 N BLUE CROSSING WAY
TUCSON AZ
85743-5211
US

V. Phone/Fax

Practice location:
  • Phone: 520-229-3203
  • Fax:
Mailing address:
  • Phone: 520-229-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6739
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: