Healthcare Provider Details

I. General information

NPI: 1730395583
Provider Name (Legal Business Name): LESLIE ALLEN COTTON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 NE 78TH ST
VANCOUVER WA
98665-9631
US

IV. Provider business mailing address

1418 NE 78TH ST
VANCOUVER WA
98665-9631
US

V. Phone/Fax

Practice location:
  • Phone: 360-687-7777
  • Fax: 360-687-6090
Mailing address:
  • Phone: 360-687-7777
  • Fax: 360-687-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: