Provider Demographics
NPI:1215607551
Name:SAPANA KOTHARY PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:SAPANA KOTHARY PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:ZAMORANO
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:408-504-4935
Mailing Address - Street 1:5669 LA SEYNE PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2240
Mailing Address - Country:US
Mailing Address - Phone:408-504-4935
Mailing Address - Fax:
Practice Address - Street 1:15075 LOS GATOS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2049
Practice Address - Country:US
Practice Address - Phone:408-504-4935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Multi-Specialty