Provider Demographics
NPI:1942516273
Name:KOTKE, DANIEL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:KOTKE
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 1:3603 W CORTARO FARMS RD STE 113
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-1219
Mailing Address - Country:US
Mailing Address - Phone:520-572-1593
Mailing Address - Fax:520-572-0793
Practice Address - Street 1:3603 W CORTARO FARMS RD STE 113
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-1219
Practice Address - Country:US
Practice Address - Phone:520-572-1593
Practice Address - Fax:520-572-0793
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD47181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice