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General NPI Number Information
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NPI Number | 1043678055
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Entity Type | Organization
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Legal Business Name | COTTONWOOD DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 830 S MAIN ST SUITE 1 D
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4620
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Country | US
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Telephone | 928-634-5566
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Fax | 928-634-1363
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Provider Business Mailing Address
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Address Line | 830 S MAIN ST SUITE 1 D
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4620
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Country | US
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Telephone | 928-634-5566
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Fax | 928-634-1363
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRUCE EDWIN WESTOVER
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Credential | DDS
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Telephone | 928-634-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D03477
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License Number State | AZ
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