Provider Demographics
NPI:1467662577
Name:KOTHARI, PRIYA D (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:D
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19 ROCK HILL RD APT 6C
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2000
Mailing Address - Country:US
Mailing Address - Phone:610-668-1064
Mailing Address - Fax:
Practice Address - Street 1:1814 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3532
Practice Address - Country:US
Practice Address - Phone:248-608-8169
Practice Address - Fax:248-608-8149
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry