Provider Demographics
NPI:1194790873
Name:ALAN D. MARCOTTE DDS
Entity type:Organization
Organization Name:ALAN D. MARCOTTE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-221-7737
Mailing Address - Street 1:810 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2835
Mailing Address - Country:US
Mailing Address - Phone:620-221-7737
Mailing Address - Fax:620-221-2351
Practice Address - Street 1:810 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2835
Practice Address - Country:US
Practice Address - Phone:620-221-7737
Practice Address - Fax:620-221-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3960OtherDELTA DENTAL ID
KS17259OtherBCBS GROUP ID
KS19308OtherBCBS INDIVIDUAL ID