Provider Demographics
NPI:1548280472
Name:KOTZEN, MITCHELL W (DMD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:W
Last Name:KOTZEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:1104
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2392
Mailing Address - Country:US
Mailing Address - Phone:413-525-6123
Mailing Address - Fax:413-525-8999
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:1104
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2392
Practice Address - Country:US
Practice Address - Phone:413-525-6123
Practice Address - Fax:413-525-8999
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice