Healthcare Provider Details

I. General information

NPI: 1447735949
Provider Name (Legal Business Name): SUMAN HOTHI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10216 SE 256TH ST
KENT WA
98030-6437
US

IV. Provider business mailing address

10216 SE 256TH ST
KENT WA
98030-6437
US

V. Phone/Fax

Practice location:
  • Phone: 253-856-3384
  • Fax:
Mailing address:
  • Phone: 253-856-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60865245
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: