Individual
NIDHI BAKUL KOTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1881
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1881
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030105
IL
Other
Enumeration date
02/10/2015
Last updated
02/22/2016
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