MEDICARE: COTTMON DENTAL GROUP

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

General Provider Information

NPI Number	:	1992030001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTMON DENTAL GROUP

Provider Business Mailing Address
First Line	:	2901 SECANE DR
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19154-1329
Country	:	US
Telephone Number	:	215-632-1245
Fax Number	:	215-632-8456

Provider Business Practice Location Address
First Line	:	2901 SECANE DR
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19154-1329
Country	:	US
Telephone Number	:	215-632-1245
Fax Number	:	215-632-8456

Authorized Official
Title or Position	:	PRES
Name	:	ROBERT DUBIN
Credential	:	NA
Telephone Number	:	610-639-3060

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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