Provider Demographics
NPI:1730395583
Name:COTTON, LESLIE ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ALLEN
Last Name:COTTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 NE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9631
Mailing Address - Country:US
Mailing Address - Phone:360-687-7777
Mailing Address - Fax:360-687-6090
Practice Address - Street 1:1418 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9631
Practice Address - Country:US
Practice Address - Phone:360-687-7777
Practice Address - Fax:360-687-6090
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA40631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics