Healthcare Provider Details

I. General information

NPI: 1730836859
Provider Name (Legal Business Name): KOTHARY DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15075 LOS GATOS BLVD STE 100
LOS GATOS CA
95032-2049
US

IV. Provider business mailing address

15075 LOS GATOS BLVD STE 100
LOS GATOS CA
95032-2049
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-2059
  • Fax: 408-252-1904
Mailing address:
  • Phone: 408-356-2059
  • Fax: 408-252-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

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