Individual
DR. TIFFANY OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5514
(920) 787-4737
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-6039
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
101356
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/25/2018
Last updated
02/08/2024
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