MEDICARE: COTTONWOOD DENTAL LLC

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	122300000X	Dentist	3813	NE
2	124Q00000X	Dental Hygienist	933	NE
3	124Q00000X	Dental Hygienist	2418	NE
4	122300000X	Dentist	4294	NE
5	122300000X	Dentist	7101	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4294	OTHER	NE	DENTIST

General Provider Information

NPI Number	:	1699005124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTONWOOD DENTAL LLC

Provider Business Mailing Address
First Line	:	3327 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1334
Country	:	US
Telephone Number	:	308-382-1890
Fax Number	:	308-381-4997

Provider Business Practice Location Address
First Line	:	3327 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1334
Country	:	US
Telephone Number	:	308-382-1890
Fax Number	:	308-381-4997

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL L BROWN MCDONALD
Credential	:	DDS
Telephone Number	:	308-382-1890

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	11/16/2023

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Directions to “COTTONWOOD DENTAL LLC ” Practice Location

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