Provider Demographics
NPI:1780637454
Name:KOTCHICK, CHRISTOPHER J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:KOTCHICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ADAMS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-346-7301
Mailing Address - Fax:570-346-7575
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-346-7301
Practice Address - Fax:570-346-7575
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029776L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU86857Medicare UPIN