MEDICARE: PALAK PRAVINKUMAR KOTHIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	40013	TX

General Provider Information

NPI Number	:	1942086798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PALAK PRAVINKUMAR KOTHIA

Provider Business Mailing Address
First Line	:	331 W HARWOOD RD STE A
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-3048
Country	:	US
Telephone Number	:	817-510-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3007
Country	:	US
Telephone Number	:	469-361-8088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	02/12/2026

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