Healthcare Provider Details

I. General information

NPI: 1215607551
Provider Name (Legal Business Name): SAPANA KOTHARY PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15075 LOS GATOS BLVD STE 120
LOS GATOS CA
95032-2049
US

IV. Provider business mailing address

5669 LA SEYNE PL
SAN JOSE CA
95138-2240
US

V. Phone/Fax

Practice location:
  • Phone: 408-504-4935
  • Fax:
Mailing address:
  • Phone: 408-504-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOFIA MARGARITA ZAMORANO
Title or Position: OFFICE MANAGER
Credential: RDA
Phone: 408-504-4935