Individual
DR. MARIVIN OTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
317 W CHERRY LN, MERIDIAN, ID 83642-1608
(208) 888-2055
(208) 895-0583
Mailing address
317 W CHERRY LN, MERIDIAN, ID 83642-1608
(208) 888-2055
(208) 895-0583
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3750
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8067150
—
ID
Enumeration date
11/11/2006
Last updated
07/09/2007
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