Provider Demographics
NPI:1285090571
Name:KOTHARI, ANUJA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ANUJA
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2421
Mailing Address - Country:US
Mailing Address - Phone:630-830-9700
Mailing Address - Fax:
Practice Address - Street 1:820 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2421
Practice Address - Country:US
Practice Address - Phone:630-830-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029518122300000X
IL0210027251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist