Healthcare Provider Details

I. General information

NPI: 1386238848
Provider Name (Legal Business Name): KOTHARY PROFESSIONAL DENTAL CORPORATION EZ DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 COTTLE RD STE 240
SAN JOSE CA
95123-3764
US

IV. Provider business mailing address

5730 COTTLE RD STE 240
SAN JOSE CA
95123-3764
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-6000
  • Fax:
Mailing address:
  • Phone: 408-227-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAPANA KOTHARY DDS
Title or Position: OWNER
Credential: DDS
Phone: 408-656-9657