Individual
DR. WAYNE WILKINSON COTTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1637
Mailing address
10465 E PLATA AVE, MESA, AZ 85212-1840
(480) 984-4002
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
272632-9922
UT
1223G0001X
General Practice Dentistry
D3102
ID
1223G0001X
General Practice Dentistry
D7446
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0410520
BCBS
AZ
05
—
857740
—
AZ
Enumeration date
11/14/2006
Last updated
10/08/2012
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