Provider Demographics
NPI:1578172763
Name:FLAVIO A KOTTAR DDS, P.A.
Entity Type:Organization
Organization Name:FLAVIO A KOTTAR DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FLAVIO
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:KOTTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-331-9998
Mailing Address - Street 1:1300 BRICKELL BAY DR APT 3105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3399
Mailing Address - Country:US
Mailing Address - Phone:305-331-9998
Mailing Address - Fax:
Practice Address - Street 1:3683 S MIAMI AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4253
Practice Address - Country:US
Practice Address - Phone:305-331-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental