Individual
SUZANNE K OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTAL HYGENIST
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Mailing address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
020.012262
IL
124Q00000X
Dental Hygienist
Primary
10133-16
WI
Other
Enumeration date
01/27/2010
Last updated
01/27/2010
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