Basic Information
| Provider Information | |||||||||
| NPI: | 1578878435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOTI | ||||||||
| FirstName: | SUSMITHA RAO | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 NORTHCHASE PKWY SE | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300676405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789045665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1740 W 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974023619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4582103543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2010 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 27635 | TX | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN014164 | GA | N | Dental Providers | Dentist | General Practice | 1223P0221X | D11308 | OR | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.