Organization Name: | OTERO & OTERO DDS PA |
NPI Number: | 1023266954 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MISAEL J OTERO (DENTIST, OWNER) |
Mailing Address: | 14057 Us Highway 17 Suite 120 Hampstead |
State: | NC US |
Postal Code: | 28443 |
Phone Number: | 9102709344 |
Fax Number: | |
NPI Enumeration Date: | 09/04/2008 |
NPI Last Update Date: | 09/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 8058 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |