Provider Demographics
NPI:1558933689
Name:KOTHARI, RUSHI (DMD)
Entity Type:Individual
Prefix:
First Name:RUSHI
Middle Name:
Last Name:KOTHARI
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 GREEN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2948
Mailing Address - Country:US
Mailing Address - Phone:646-407-0285
Mailing Address - Fax:
Practice Address - Street 1:1710 GREEN HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2948
Practice Address - Country:US
Practice Address - Phone:646-407-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02846100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist