Susan Gail Cottrell, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 13050 Issued in FL

Practice address

Lecom
101 Lecom Way
Defuniak Springs, FL 32435

Phone

(850) 951-0200

Fax

(850) 951-6706

NPI assigned

Jun 12, 2006

Last updated

Aug 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Susan Cottrell Kelly Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lake Erie College of Osteopathic Medicine

  • General Practice Dentistry
  • Defuniak Springs, FL
  • NPI 1710422670
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1467494427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3799 E CR 30A",
            "city": "SANTA ROSA BCH",
            "state": "FL",
            "postal_code": "34259",
            "telephone_number": "850-586-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LECOM",
            "address_2": "101 LECOM WAY",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "32435",
            "telephone_number": "850-951-0200",
            "fax_number": "850-951-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTTRELL",
        "first_name": "SUSAN",
        "middle_name": "GAIL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 13050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "KELLY",
            "middle_name": "COTTRELL",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rachel Kyleen Collinsworth, RBT
• Donna Pearl Comito, LMT
• Stephanie Cook, BCBA
• Holly Nicole Coots
• Shelley Leeann Cotton
• County of Walton Board of County Commissioners (Walton County Ambulance)
• County of Walton Office of Sheriff (Walton County Fire Rescue)
• Derrick Carl Crampton, PT
• Crestview Hospital Corporation (Gateway Medical Clinic - Defuniak Springs)
• Crestview Hospital Corporation (Gateway Medical Clinic DeFuniak)

• General Practice Dentistry in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.