Provider Demographics
NPI:1932269388
Name:KOTTAS, KATHERINE CAROLINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CAROLINE
Last Name:KOTTAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:CAROLINE
Other - Last Name:NEWMARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1327 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-2116
Mailing Address - Country:US
Mailing Address - Phone:612-866-1327
Mailing Address - Fax:
Practice Address - Street 1:1905 PLAZA DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2883
Practice Address - Country:US
Practice Address - Phone:651-686-6678
Practice Address - Fax:651-686-5504
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND116021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice