Healthcare Provider Details

I. General information

NPI: 1467662577
Provider Name (Legal Business Name): PRIYA D. KOTHARI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3532
US

IV. Provider business mailing address

19 ROCK HILL RD APT 6C
BALA CYNWYD PA
19004-2000
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-8169
  • Fax: 248-608-8149
Mailing address:
  • Phone: 610-668-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901019531
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: