Provider Demographics
NPI:1417327198
Name:KOTHA, ABHIROOP (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABHIROOP
Middle Name:
Last Name:KOTHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 W JOE HARVEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-0820
Mailing Address - Country:US
Mailing Address - Phone:575-738-0335
Mailing Address - Fax:575-738-0033
Practice Address - Street 1:1710 W JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0820
Practice Address - Country:US
Practice Address - Phone:575-738-0335
Practice Address - Fax:575-738-0033
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570581223G0001X
NMDD44151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice