Provider Demographics
NPI:1679823264
Name:KOTHARI, HEMALI (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:HEMALI
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W THOMAS RD STE 320
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4415
Mailing Address - Country:US
Mailing Address - Phone:602-406-3560
Mailing Address - Fax:
Practice Address - Street 1:124 W THOMAS RD STE 320
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4415
Practice Address - Country:US
Practice Address - Phone:602-406-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD000001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics