MEDICARE: DR. DAVID MICHAEL COTTRELL D.D.S.

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	1223P0221X	Pediatric Dentistry	35239	CA

General Provider Information

NPI Number	:	1457353922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL COTTRELL D.D.S.

Provider Business Mailing Address
First Line	:	7343 EL CAMINO REAL
Second Line	:	SUITE 350
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4697
Country	:	US
Telephone Number	:	805-459-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 SHEPARD DR
Second Line	:	SUITE 201
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-7020
Country	:	US
Telephone Number	:	805-922-2888
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	03/02/2015

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