MEDICARE: DR. DOUGLAS FRANKLIN COTTINGHAM DMD

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	DGD.4695 GD	SC

General Provider Information

NPI Number	:	1366762858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS FRANKLIN COTTINGHAM DMD

Provider Business Mailing Address
First Line	:	6420 GARNERS FERRY RD
Second Line	:	SUITE X
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1632
Country	:	US
Telephone Number	:	803-776-4234
Fax Number	:	803-776-4900

Provider Business Practice Location Address
First Line	:	6420 GARNERS FERRY RD
Second Line	:	SUITE X
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1632
Country	:	US
Telephone Number	:	803-776-4234
Fax Number	:	803-776-4900

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	11/15/2012

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