# LISA M KOTCH DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790958437
- **Authorized official:** LISA M KOTCH DMD (PRESIDENT)
- **Authorized official phone:** (570) 714-8073

## Contact information

- **Practice address:** 333 WYOMING AVE, KINGSTON, PA 18704-3502
- **Practice address phone:** (570) 714-8083
- **Mailing address:** 333 WYOMING AVE, KINGSTON, PA 18704-3502
- **Mailing address phone:** (570) 714-8083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2008
- **Last updated:** 04/02/2008