Provider Demographics
NPI:1356475123
Name:KOTHARI, YOGINI A (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOGINI
Middle Name:A
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:YOGINI
Other - Middle Name:A
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2660 ROUTE 16 N
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-9723
Mailing Address - Country:US
Mailing Address - Phone:716-373-8303
Mailing Address - Fax:716-373-7555
Practice Address - Street 1:2660 ROUTE 16 N
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-9723
Practice Address - Country:US
Practice Address - Phone:716-373-8303
Practice Address - Fax:716-373-7555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04142611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01133480Medicaid