Healthcare Provider Details

I. General information

NPI: 1356475123
Provider Name (Legal Business Name): YOGINI A KOTHARI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YOGINI A PATEL

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 ROUTE 16 N
OLEAN NY
14760-9723
US

IV. Provider business mailing address

2660 ROUTE 16 N
OLEAN NY
14760-9723
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-8303
  • Fax: 716-373-7555
Mailing address:
  • Phone: 716-373-8303
  • Fax: 716-373-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0414261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: