Palak Jayantilal Kothari, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6001495-15 Issued in WI

Practice address

124 E Drexel Ave
Oak Creek, WI 53154-2123

Phone

(262) 533-8387

NPI assigned

Jun 5, 2024

Last updated

Jun 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nova Dental LLC

  • General Practice Dentistry
  • Kenosha, WI
  • NPI 1588515159
  NPD Authorized official
• Dental 360 Oak Creek LLC

  • General Practice Dentistry
  • Oak Creek, WI
  • NPI 1518676857
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1063253862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7971 S 6TH ST APT 119",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531542011",
            "telephone_number": "973-626-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E DREXEL AVE",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531542123",
            "telephone_number": "262-533-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHARI",
        "first_name": "PALAK",
        "middle_name": "JAYANTILAL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001495-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel R Koester, D.D.S.
• Jeanette Ann Kohlbeck-Zalar, LPN
• Andrea Frances Kolodziej, ATC, LAT
• Michelle Kondrat, CCC-SLP
• Kristin Konicek, PT, DPT, COMT
• Patrycja A Koziara
• Jennifer Lynn Kreuser
• Kathleen Kreuziger, OTR
• Kenneth Douglas Krimpelbein, DC
• Kristen K Freiberg LLC

• General Practice Dentistry in Oak Creek, WI
• Providers in Oak Creek, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.