Provider Demographics
NPI:1871680439
Name:KOTIL, DARIN LEE (DDS)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:LEE
Last Name:KOTIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14450 EAGLE RUN DR STE 290
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1493
Mailing Address - Country:US
Mailing Address - Phone:402-964-9009
Mailing Address - Fax:402-964-1077
Practice Address - Street 1:14450 EAGLE RUN DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116
Practice Address - Country:US
Practice Address - Phone:402-964-9009
Practice Address - Fax:402-964-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084257700Medicare ID - Type Unspecified