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General NPI Number Information
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NPI Number | 1538443528
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Entity Type | Individual
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Provider Name | JYOTHI KOTIAN VASANTHA DDS
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Gender | Female
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Dates
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Enumeration Date | 10/08/2011
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1261 BRIDGETON PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-2942
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Country | US
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Telephone | 615-486-9157
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Fax |
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Provider Business Mailing Address
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Address Line | 1261 BRIDGETON PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-8341
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Country | US
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Telephone | 615-468-9157
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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 | DS0000009360
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License Number State | TN
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