Provider Demographics
NPI:1194853432
Name:DR. STEPHEN J. KOTKIS
Entity Type:Organization
Organization Name:DR. STEPHEN J. KOTKIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOTKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-989-5566
Mailing Address - Street 1:3939 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6749
Mailing Address - Country:US
Mailing Address - Phone:954-989-5566
Mailing Address - Fax:954-989-5567
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6749
Practice Address - Country:US
Practice Address - Phone:954-989-5566
Practice Address - Fax:954-989-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN58671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85624Medicare ID - Type Unspecified