Provider Demographics
NPI:1528110087
Name:COTTON, DOUGLAS VAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:VAN
Last Name:COTTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:VAN
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:409 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3507
Mailing Address - Country:US
Mailing Address - Phone:812-288-4691
Mailing Address - Fax:812-288-7178
Practice Address - Street 1:409 W 6TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3507
Practice Address - Country:US
Practice Address - Phone:812-288-4691
Practice Address - Fax:812-288-7178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice