Individual
DR. LISA RAE OTOUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
275 N NC 16 BUSINESS HWY STE 204B, DENVER, NC 28037-3000
(704) 275-5556
Mailing address
14928 NICHOLS HALL DR, CHARLOTTE, NC 28273-7504
(919) 360-2353
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10960
NC
1223G0001X
General Practice Dentistry
Primary
32631
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX9605
—
SC
Enumeration date
06/16/2014
Last updated
06/17/2024
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