Provider Demographics
NPI:1114046901
Name:KOTHARI, SADHANA SAMIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SADHANA
Middle Name:SAMIR
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SANA
Other - Middle Name:S
Other - Last Name:KOTHARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3332 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6304
Mailing Address - Country:US
Mailing Address - Phone:916-483-0178
Mailing Address - Fax:916-483-0136
Practice Address - Street 1:3332 BALMORAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6304
Practice Address - Country:US
Practice Address - Phone:916-483-0178
Practice Address - Fax:916-483-0136
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0333071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA033307OtherDENTAL LICENSE NUMBER