Provider Demographics
NPI:1023266954
Name:OTERO & OTERO DDS PA
Entity type:Organization
Organization Name:OTERO & OTERO DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MISAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-270-9344
Mailing Address - Street 1:14057 US HIGHWAY 17
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:910-270-9344
Mailing Address - Fax:
Practice Address - Street 1:14057 US HIGHWAY 17
Practice Address - Street 2:SUITE 120
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-270-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8058261QD0000X
NC8019261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental