Provider Demographics
NPI:1366502726
Name:COTANT FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:COTANT FAMILY DENTISTRY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:COTANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-684-2733
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:112 HIGH STREET
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834
Mailing Address - Country:US
Mailing Address - Phone:307-684-2733
Mailing Address - Fax:307-684-2437
Practice Address - Street 1:112 HIGH STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834
Practice Address - Country:US
Practice Address - Phone:307-684-2733
Practice Address - Fax:307-684-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY807124Q00000X
WY841124Q00000X
WY1129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121328800Medicaid
WY121329600Medicaid