Provider Demographics
NPI:1922465020
Name:LOS GATOS DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:LOS GATOS DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
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:408-884-8455
Mailing Address - Street 1:15075 LOS GATOS BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-884-8155
Mailing Address - Fax:408-252-1904
Practice Address - Street 1:15075 LOS GATOS BLVD
Practice Address - Street 2:STE 120
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-884-8155
Practice Address - Fax:408-252-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty