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NPI Code Detail

MEDICARE: TONYA K COTTLE FUQUA D.D.S.

MEDICARE: TONYA K COTTLE FUQUA 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
1122300000XDentist18301TX

General Provider Information

NPI Number : 1508907940
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA K COTTLE FUQUA D.D.S.
Provider Business Mailing Address
First Line : 1300 W LANCASTER AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-3410
Country : US
Telephone Number : 817-390-2858
Fax Number : 817-390-2901
Provider Business Practice Location Address
First Line : 1300 W LANCASTER AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-3410
Country : US
Telephone Number : 817-390-2858
Fax Number : 817-390-2901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/08/2007

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Directions to “ TONYA K COTTLE FUQUA D.D.S.” Practice Location

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