Active NPI
Brett E Cotham, D.D.S.
- Dentist
- Joplin, MO
National Provider Identifier
1376807537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3886
- Practice address
- 614 E 32ND St
Joplin, MO 64804-3905 - Phone
- (417) 781-6322
- NPI assigned
- Jul 2, 2012
- Last updated
- Feb 5, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3886 | AR | Primary |
| Dentist | 122300000X | 2012015653 | MO |
Addresses
Primary practice location
614 E 32ND St
Joplin, MO 64804-3905
Mailing address
614 E 32ND Street
Joplin, MO 64804
Phone (417) 781-6322
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3886 | Other | AR | STATE LICENSE |
| 2012015653 | Other | MO | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3886 | AR | MD | Dentist |
| 2012015653 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Dental,PLLC | Dentist | Past | Accepting new patients |
| All About Smiles | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1932269628
-
- Dentist
- Fayetteville, AR
- NPI 1801210844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707091200000",
"number": "1376807537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 E 32ND STREET",
"city": "JOPLIN",
"state": "MO",
"postal_code": "64804",
"telephone_number": "417-781-6322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "614 E 32ND ST",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648043905",
"telephone_number": "417-781-6322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COTHAM",
"first_name": "BRETT",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-02",
"last_updated": "2024-02-05",
"certification_date": "2024-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "3886",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2012015653",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "3886",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "2012015653",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Joplin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.