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General NPI Number Information
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NPI Number | 1245913631
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Entity Type | Organization
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Legal Business Name | DR. JACQUELINE COOTES, DDS INC.
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 732 W 9TH ST STE 204
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City | SAN PEDRO
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State | CA
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Zip | 90731-3629
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Country | US
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Telephone | 310-833-1386
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Fax |
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Provider Business Mailing Address
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Address Line | 42 EASTFIELD DR
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City | ROLLING HILLS
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State | CA
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Zip | 90274-5262
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Country | US
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Telephone | 310-293-9985
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JACQUELINE ELISE COOTES
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Credential | DDS
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Telephone | 310-293-9985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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