Jacqueline Kotula, DDS, Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

JACQUELINE KOTULA, DDS, INC.

Practice address

4050 Redwood Hwy Ste a
San Rafael, CA 94903-5149

Phone

(415) 499-7700

NPI assigned

Mar 2, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Jacqueline Kotula, DDSNPI 1659682888

Title

Owner

Phone

(415) 499-7700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marin Dental Care Doing business as

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline M Kotula, DDS

  • Dentist
  • San Francisco, CA
  • NPI 1659682888
  NPD Authorized official
• Steven S Chase, DDS

  • General Practice Dentistry
  • San Rafael, CA
  • NPI 1639398092
  NPD (past)

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

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1457008179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 REDWOOD HWY STE A",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949035149",
            "telephone_number": "415-499-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 REDWOOD HWY STE A",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949035149",
            "telephone_number": "415-499-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE KOTULA, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "KOTULA",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-499-7700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1",
            "identifier": "1659682888",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drkotula@marindentalcare.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4050 Redwood Hwy Ste A",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949035149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Marin Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Annette Jackson
• Phoenix Jackson
• Talita Calazans Jackson, MA, LMFT
• Larry Alan Jacobs, MFT
• Jessica Jacobson, MSW
• Jacqueline S Chan DO a Medical Corporation
• Ruth Jaeger, LCSW
• James D Taylor MD Inc
• Meghan L James
• Hyunae Jang, D.M.D

• Dental Clinic/Center in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.