MEDICARE: JEREMY KOTT DDS PC

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	1223E0200X	Endodontics	9557	CO

General Provider Information

NPI Number	:	1184935751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY KOTT DDS PC

Provider Business Mailing Address
First Line	:	1401 WYNKOOP ST
Second Line	:	SUITE 170
City	:	DENVER
State	:	CO
Zip	:	80202-1729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 WYNKOOP ST
Second Line	:	SUITE 170
City	:	DENVER
State	:	CO
Zip	:	80202-1729
Country	:	US
Telephone Number	:	734-223-2678
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEREMY M KOTT
Credential	:	DDS
Telephone Number	:	734-223-2678

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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