Provider Demographics
NPI:1770021800
Name:KOTKIN, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KOTKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26910 GRAND CENTRAL PKWY APT 28S
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11005-1028
Mailing Address - Country:US
Mailing Address - Phone:516-567-6332
Mailing Address - Fax:
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 309
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4477
Practice Address - Country:US
Practice Address - Phone:302-644-4460
Practice Address - Fax:302-644-4470
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0600061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program