Healthcare Provider Details

I. General information

NPI: 1528345188
Provider Name (Legal Business Name): RISHI A KOTHARI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BROADWAY SUITE 104
SLEEPY HOLLOW NY
10591-2670
US

IV. Provider business mailing address

245 N BROADWAY SUITE 104
SLEEPY HOLLOW NY
10591-2670
US

V. Phone/Fax

Practice location:
  • Phone: 914-332-0900
  • Fax: 914-214-5308
Mailing address:
  • Phone: 914-332-0900
  • Fax: 914-214-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number055809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: