Provider Demographics
NPI:1316954084
Name:KOTWAS, JAMES RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:KOTWAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 738
Mailing Address - Street 2:687 STATE RD
Mailing Address - City:MANOMET
Mailing Address - State:MA
Mailing Address - Zip Code:02345-0738
Mailing Address - Country:US
Mailing Address - Phone:508-224-6302
Mailing Address - Fax:508-224-6362
Practice Address - Street 1:687 STATE ROAD
Practice Address - Street 2:
Practice Address - City:MANOMET
Practice Address - State:MA
Practice Address - Zip Code:02345
Practice Address - Country:US
Practice Address - Phone:508-224-6302
Practice Address - Fax:508-224-6362
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice