Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN19353 | FL |
Y | 1223D0001X | Dental Public Health | 27272 | TX |
NPI | 1720372725 |
---|---|
Provider Name | Dr. Charles Cotton |
First Address | Austin, TX 78758-3801 |
Second Address | Austin, TX 78758-3801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 06/03/2017 |