Healthcare Provider Details

I. General information

NPI: 1942851068
Provider Name (Legal Business Name): ASHLEY KOTHMANN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24051 W INTERSTATE 10
SAN ANTONIO TX
78257-1174
US

IV. Provider business mailing address

148 ROLLING CRK
BOERNE TX
78006-1996
US

V. Phone/Fax

Practice location:
  • Phone: 210-681-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35560
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: