Healthcare Provider Details

I. General information

NPI: 1326148842
Provider Name (Legal Business Name): EDWARD A KOTZ JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 CAPITAL CIR NE
TALLAHASSEE FL
32308-4421
US

IV. Provider business mailing address

1913 CAPITAL CIR NE
TALLAHASSEE FL
32308-4421
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5131
  • Fax: 850-878-3521
Mailing address:
  • Phone: 850-878-5131
  • Fax: 850-878-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN5877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: