Provider Demographics
NPI:1588140990
Name:KATHAROTIYA, PRADIP C (DDS)
Entity type:Individual
Prefix:DR
First Name:PRADIP
Middle Name:C
Last Name:KATHAROTIYA
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 1:2205 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9355
Mailing Address - Country:US
Mailing Address - Phone:213-400-5118
Mailing Address - Fax:
Practice Address - Street 1:3430 TULLY RD STE 21
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0840
Practice Address - Country:US
Practice Address - Phone:209-422-6176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1028221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice