Basic Information
| Provider Information | |||||||||
| NPI: | 1174807861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOTZIN | ||||||||
| FirstName: | ROXANE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522125 | ||||||||
| FaxNumber: | 5039522237 | ||||||||
| Practice Location | |||||||||
| Address1: | 4104 SE 82ND AVE STE 450 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972662958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037714324 | ||||||||
| FaxNumber: | 5037714458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2011 | ||||||||
| LastUpdateDate: | 04/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D9629 | OR | Y | Dental Providers | Dentist | General Practice |
No ID Information.