=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528253176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER W. KOTERWAS, D.D.S.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2007
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 E PULASKI HWY
-----------------------------------------------------
City | ELKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21921-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-392-3737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 E PULASKI HWY
-----------------------------------------------------
City | ELKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21921-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-392-3737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. EMILIA R KOTERWAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-392-3737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6583
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------