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Individual
DR. DOUGLAS WADE OTOPALIK
Active
Individual
DR. DOUGLAS WADE OTOPALIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10057
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
299220500
MEDICAL ASSISTANCE PROV #
MN
Enumeration date
12/01/2005
Last updated
02/02/2012
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