Healthcare Provider Details

I. General information

NPI: 1124556170
Provider Name (Legal Business Name): ANUSHA KOTHA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 DACY LN
KYLE TX
78640-6322
US

IV. Provider business mailing address

2810 DACY LN
KYLE TX
78640-6322
US

V. Phone/Fax

Practice location:
  • Phone: 210-233-7000
  • Fax: 210-625-5689
Mailing address:
  • Phone: 210-233-7000
  • Fax: 210-625-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: