Individual
DR. DOUGLAS WADE OTOPALIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
111 STAR ST, SUITE 109, MANKATO, MN 56001-4888
(507) 387-3249
(507) 387-7175
Mailing address
127 RED OAK DR, MANKATO, MN 56001-8996
(507) 317-2291
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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