Provider Demographics
NPI:1386238848
Name:KOTHARY PROFESSIONAL DENTAL CORPORATION EZ DENTAL
Entity type:Organization
Organization Name:KOTHARY PROFESSIONAL DENTAL CORPORATION EZ DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHARY DDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-656-9657
Mailing Address - Street 1:5730 COTTLE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3764
Mailing Address - Country:US
Mailing Address - Phone:408-227-6000
Mailing Address - Fax:
Practice Address - Street 1:5730 COTTLE RD STE 240
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3764
Practice Address - Country:US
Practice Address - Phone:408-227-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty