Healthcare Provider Details

I. General information

NPI: 1285090571
Provider Name (Legal Business Name): ANUJA KOTHARI D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S BARTLETT RD
STREAMWOOD IL
60107-2421
US

IV. Provider business mailing address

820 S BARTLETT RD
STREAMWOOD IL
60107-2421
US

V. Phone/Fax

Practice location:
  • Phone: 630-830-9700
  • Fax:
Mailing address:
  • Phone: 630-830-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019029518
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021002725
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: