Provider Demographics
NPI:1730072968
Name:OTIS, YVONNE (DMD)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:OTIS
Suffix:
Gender:X
Credentials:DMD
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:JAQUELINE
Other - Last Name:OTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:YVONNE OTIS DMD
Mailing Address - Street 1:113 VALLEY VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-9602
Mailing Address - Country:US
Mailing Address - Phone:802-476-3140
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:802-595-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program