| Jacqueline Kotula, Dds, Inc. | |
|
4050 Redwood Hwy Ste A San Rafael CA 94903-5149 | |
| (415) 499-7700 | |
| Not Available |
| Full Name | Jacqueline Kotula, Dds, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4050 Redwood Hwy Ste A, San Rafael, California |
| Authorized Official Name and Position | Jacqueline Kotula (OWNER) |
| Authorized Official Contact | 4154997700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline Kotula, Dds, Inc. 4050 Redwood Hwy Ste A San Rafael CA 94903-5149 Ph: (415) 499-7700 | Jacqueline Kotula, Dds, Inc. 4050 Redwood Hwy Ste A San Rafael CA 94903-5149 Ph: (415) 499-7700 |
| NPI Number | 1457008179 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 03/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457008179 | NPI | - | NPPES |
| 1659682888 | Other | CA | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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