Provider Demographics
NPI:1194165480
Name:COTTON, KYLE JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JAMES
Last Name:COTTON
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 1:406 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2520
Mailing Address - Country:US
Mailing Address - Phone:318-797-0006
Mailing Address - Fax:
Practice Address - Street 1:406 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2520
Practice Address - Country:US
Practice Address - Phone:318-797-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist