Provider Demographics
NPI:1215065552
Name:KOTKIS, STEPHEN J (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:KOTKIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6749
Mailing Address - Country:US
Mailing Address - Phone:954-989-5566
Mailing Address - Fax:954-989-5567
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6749
Practice Address - Country:US
Practice Address - Phone:954-989-5566
Practice Address - Fax:954-989-5567
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN58671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85624OtherBC-BS
FL85624OtherPTAN
FL85624OtherBC-BS