Provider Demographics
NPI:1538724828
Name:COTTER & EASTON GENERAL DENTISTRY, PLLC
Entity type:Organization
Organization Name:COTTER & EASTON GENERAL DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WALDEMAR
Authorized Official - Last Name:EASTON II
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-357-5683
Mailing Address - Street 1:1125 THOMAS EDISON DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8500
Mailing Address - Country:US
Mailing Address - Phone:810-982-9821
Mailing Address - Fax:810-982-9645
Practice Address - Street 1:1125 THOMAS EDISON DR
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8500
Practice Address - Country:US
Practice Address - Phone:810-982-9821
Practice Address - Fax:810-982-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty