Provider Demographics
NPI:1992919633
Name:KOTT, JEREMY M (DDS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:KOTT
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 1:12200 E CORNELL AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3423
Mailing Address - Country:US
Mailing Address - Phone:303-337-0304
Mailing Address - Fax:
Practice Address - Street 1:12200 E CORNELL AVE
Practice Address - Street 2:UNIT E
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80014-3423
Practice Address - Country:US
Practice Address - Phone:303-337-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188621223E0200X
CO95571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics