Individual
TAPAN KOTICHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BDS, MDS
Contact information
Practice address
16430 MUIRFIELD PLACE, EDMOND, OK 73013-9161
(405) 696-0908
Mailing address
16913 SHORERUN DR, EDMOND, OK 73012-8440
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901020564
MI
1223P0300X
Periodontics
Primary
72
OK
Other
Enumeration date
12/08/2011
Last updated
12/14/2023
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