Provider Demographics
NPI:1386651602
Name:KOTAPISH, JR., JAMES GEORGE (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GEORGE
Last Name:KOTAPISH, JR.
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SMITH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4452
Mailing Address - Country:US
Mailing Address - Phone:330-666-0400
Mailing Address - Fax:330-666-0130
Practice Address - Street 1:3075 SMITH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4452
Practice Address - Country:US
Practice Address - Phone:330-666-0400
Practice Address - Fax:330-666-0130
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics