Provider Demographics
NPI:1447366323
Name:PHILLIP D KOTHMANN DDS MS INC
Entity type:Organization
Organization Name:PHILLIP D KOTHMANN DDS MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:KOTHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:325-942-9673
Mailing Address - Street 1:4337 COLLEGE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-942-9673
Mailing Address - Fax:325-942-0369
Practice Address - Street 1:4337 COLLEGE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-942-9673
Practice Address - Fax:325-942-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty