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General NPI Number Information
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NPI Number | 1376052043
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Entity Type | Individual
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Provider Name | BHOOMI KOTAK DMD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 60 EAST ST STE 2500
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City | METHUEN
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State | MA
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Zip | 01844-4519
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Country | US
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Telephone | 978-788-9303
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Fax | 978-237-4003
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Provider Business Mailing Address
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Address Line | 320 MIDDLESEX AVE UNIT C208
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City | MEDFORD
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State | MA
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Zip | 02155-5084
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Country | US
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Telephone | 603-930-1124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019031413
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN1857832
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857832
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License Number State | MA
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