Provider Demographics
NPI:1437797495
Name:JEFFREY C KOTZ DMD PA
Entity Type:Organization
Organization Name:JEFFREY C KOTZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:KOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-225-9002
Mailing Address - Street 1:846 SAINT ANDREWS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7148
Mailing Address - Country:US
Mailing Address - Phone:843-225-9002
Mailing Address - Fax:843-695-6995
Practice Address - Street 1:846 SAINT ANDREWS BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7148
Practice Address - Country:US
Practice Address - Phone:843-225-9002
Practice Address - Fax:843-695-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty