Basic Information
| Provider Information | |||||||||
| NPI: | 1679823264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOTHARI | ||||||||
| FirstName: | HEMALI | ||||||||
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| Credential: | D.M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 W THOMAS RD STE 320 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063560 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 124 W THOMAS RD STE 320 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063560 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | D00000 | AZ | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.