Individual
DIANE COLETTE KOTHERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(414) 897-5193
Mailing address
311 E ERIE ST UNIT 317, MILWAUKEE, WI 53202-6046
(414) 379-2593
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5122-16
WI
Other
Enumeration date
05/16/2018
Last updated
05/16/2018
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