Provider Demographics
NPI:1033486121
Name:COTTON, LA RON WHAYLON (DDS)
Entity type:Individual
Prefix:
First Name:LA RON
Middle Name:WHAYLON
Last Name:COTTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 E LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-8406
Mailing Address - Country:US
Mailing Address - Phone:714-865-3989
Mailing Address - Fax:
Practice Address - Street 1:2638 E LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-8406
Practice Address - Country:US
Practice Address - Phone:714-865-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice