Provider Demographics
NPI:1487900726
Name:SHORES, COTY (DDS)
Entity type:Individual
Prefix:DR
First Name:COTY
Middle Name:
Last Name:SHORES
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 1:1640 W PLATO RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1264
Mailing Address - Country:US
Mailing Address - Phone:580-786-2469
Mailing Address - Fax:580-786-2470
Practice Address - Street 1:1640 W PLATO RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1264
Practice Address - Country:US
Practice Address - Phone:580-786-2469
Practice Address - Fax:580-786-2470
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice