Wayne Wilkinson Cottam, DMD

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

272632-9922 Issued in UT

Practice address

4212 N 16TH St
Phoenix, AZ 85016-5319

Phone

(602) 263-1511

Fax

(602) 263-1637

NPI assigned

Nov 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349654400000",
    "number": "1003988064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10465 E PLATA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852121840",
            "telephone_number": "480-984-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTTAM",
        "first_name": "WAYNE",
        "middle_name": "WILKINSON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2012-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7446",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3102",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "UT",
            "license": "272632-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "857740",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0410520",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tim A Cotie, MD
• Cotswold Python Enterprises LLC
• Craig John Cott, MD
• Cottage Home Care Az LLC
• Jordan Cottam, PHARMD
• Dusty V Cotter, D.V.M.
• Jennifer J. Cotter
• Mildred Cotto, LCSW
• Elaine Cottom
• Christopher M Cotton

• Public Health Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Public Health Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.