Provider Demographics
NPI:1518577667
Name:AMANDA B KOTIS, DMD, PA
Entity Type:Organization
Organization Name:AMANDA B KOTIS, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-873-4271
Mailing Address - Street 1:1207 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3511
Mailing Address - Country:US
Mailing Address - Phone:704-873-4271
Mailing Address - Fax:704-873-0705
Practice Address - Street 1:1207 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3511
Practice Address - Country:US
Practice Address - Phone:704-873-4271
Practice Address - Fax:704-873-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty