Provider Demographics
NPI:1902260466
Name:COTTEN, JOHN JR
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:COTTEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 N 9TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2406
Mailing Address - Country:US
Mailing Address - Phone:850-477-1125
Mailing Address - Fax:
Practice Address - Street 1:301 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1473
Practice Address - Country:US
Practice Address - Phone:251-943-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery