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General NPI Number Information
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NPI Number | 1942086798
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Entity Type | Individual
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Provider Name | PALAK PRAVINKUMAR KOTHIA
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Gender | Female
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 2428 GUS THOMASSON RD
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City | DALLAS
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State | TX
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Zip | 75228-3007
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Country | US
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Telephone | 469-361-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 331 W HARWOOD RD STE A
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City | HURST
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State | TX
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Zip | 76054-3048
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Country | US
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Telephone | 817-510-6565
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40013
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License Number State | TX
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