PALAK JAYANTILAL KOTHARI DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

ACTIVE

Business

Title

DMD

First Name

PALAK

Middle

JAYANTILAL

Last Name

KOTHARI

Business Name

PALAK JAYANTILAL KOTHARI DMD

Original Issue Date

07/19/2024

Effective Date

07/19/2024

Expiration Date

09/30/2027

City

OAK CREEK

State

Zip

53154

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2024