Provider Demographics
NPI:1689233280
Name:KOTHARY PROFESSIONAL DENTAL CORPORATION EZ DENTAL
Entity Type:Organization
Organization Name:KOTHARY PROFESSIONAL DENTAL CORPORATION EZ DENTAL
Other - Org Name:EZ DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAPANA
Authorized Official - Middle Name:KARSAN
Authorized Official - Last Name:KOTHARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-227-6000
Mailing Address - Street 1:5669 LA SEYNE PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2240
Mailing Address - Country:US
Mailing Address - Phone:408-266-6144
Mailing Address - Fax:
Practice Address - Street 1:5730 COTTLE RD STE 240
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3764
Practice Address - Country:US
Practice Address - Phone:408-227-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty