Provider Demographics
NPI:1366152191
Name:KOKO DENTAL CARE PLLC
Entity type:Organization
Organization Name:KOKO DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROUTIOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTCHINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-328-4661
Mailing Address - Street 1:127 RUSSELL ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3530
Mailing Address - Country:US
Mailing Address - Phone:978-328-4661
Mailing Address - Fax:
Practice Address - Street 1:570 MOODY ST APT 2
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-0520
Practice Address - Country:US
Practice Address - Phone:978-328-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty