Provider Demographics
NPI:1245646801
Name:OTTO, ABBIE J (DDS)
Entity type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:J
Last Name:OTTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-5018
Mailing Address - Country:US
Mailing Address - Phone:712-368-4351
Mailing Address - Fax:
Practice Address - Street 1:128 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-5018
Practice Address - Country:US
Practice Address - Phone:712-368-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist