Individual
SUSMITHA RAO KOTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1740 W 17TH AVE, EUGENE, OR 97402-3619
(458) 210-3543
Mailing address
1090 NORTHCHASE PKWY SE, SUITE 290, MARIETTA, GA 30067-6405
(678) 904-5665
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
27635
TX
1223G0001X
General Practice Dentistry
DN014164
GA
1223P0221X
Pediatric Dentistry
Primary
D11308
OR
Other
Enumeration date
08/16/2010
Last updated
08/27/2020
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