Provider Demographics
NPI:1174797997
Name:KOTARY, EDMOND MORRIS (DMD)
Entity type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:MORRIS
Last Name:KOTARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 SANDY DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2515
Mailing Address - Country:US
Mailing Address - Phone:814-238-2431
Mailing Address - Fax:814-235-6881
Practice Address - Street 1:2014 SANDY DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2515
Practice Address - Country:US
Practice Address - Phone:814-238-2431
Practice Address - Fax:814-235-6881
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030572-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice