Provider Demographics
NPI:1629094222
Name:KOTARY, DETAR & ASSOCIATES
Entity Type:Organization
Organization Name:KOTARY, DETAR & ASSOCIATES
Other - Org Name:KOTARY & KOTARY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOTARY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-238-2431
Mailing Address - Street 1:2014 SANDY DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2515
Mailing Address - Country:US
Mailing Address - Phone:814-238-2431
Mailing Address - Fax:814-235-6881
Practice Address - Street 1:2014 SANDY DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2515
Practice Address - Country:US
Practice Address - Phone:814-238-2431
Practice Address - Fax:814-235-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030572L1223G0001X
PADS031506L1223G0001X
PADS016742L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty