DR. GREG BRIAN OTTO, D.M.D. - NPI NUMBER 1629097308

Summary

Provider Name: DR. GREG BRIAN OTTO, D.M.D.

NPI Number: 1629097308

Clasification: Dentist (1223G0001X)

Specialization: General Practice

Address:
12711 SE MILL PLAIN BLVD
VANCOUVER, WA
ZIP 98684

Phone Number: (360) 896-4484



Detailed Information

DR. Greg Brian Otto, D.M.D. is a general practice dentist in Vancouver, WA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. The assigned NPI number for this provider is 1629097308 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

12711 SE MILL PLAIN BLVD
VANCOUVER, WA
ZIP 98684-053
Phone: (360) 896-4484

The enumeration date for this NPI number is 7/19/2006 and was last updated on 7/8/2007.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 1223G0001X Dentist General Practice 5466 WA Yes

NPI Record

No. Field Name Field Value
1 NPI 1629097308
2 Entity Type Code 1
3 Provider Last Name Legal Name OTTO
4 Provider First Name GREG
5 Provider Middle Name BRIAN
6 Provider Name Prefix Text DR.
7 Provider Credential Text D.M.D.
8 Provider First Line Business Practice Location Address 12711 SE MILL PLAIN BLVD
9 Provider Business Practice Location Address City Name VANCOUVER
10 Provider Business Practice Location Address State Name WA
11 Provider Business Practice Location Address Postal Code 986846053
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 3608964484
14 Provider Enumeration Date 7/19/2006
15 Last Update Date 7/8/2007
16 Provider Gender Code M
17 Healthcare Provider Taxonomy Code 1 1223G0001X
18 Provider License Number 1 5466
19 Provider License Number State Code 1 WA
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Sole Proprietor N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.