MEDICARE: DR. ASHLY COTHERN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21267	TX

General Provider Information

NPI Number	:	1063422632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLY COTHERN DDS

Provider Business Mailing Address
First Line	:	9669 N CENTRAL EXPY
Second Line	:	SUITE 220
City	:	DALLAS
State	:	TX
Zip	:	75231-5053
Country	:	US
Telephone Number	:	214-696-9966
Fax Number	:	214-696-6776

Provider Business Practice Location Address
First Line	:	9669 N CENTRAL EXPY
Second Line	:	SUITE 220
City	:	DALLAS
State	:	TX
Zip	:	75231-5053
Country	:	US
Telephone Number	:	214-696-9966
Fax Number	:	214-696-6776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ASHLY COTHERN DDS” Practice Location

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