Individual
COLIN J OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2600 STEWART AVE, STE 266, WAUSAU, WI 54401
(715) 845-8841
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5777
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
5001643
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33558000
—
WI
Enumeration date
09/26/2006
Last updated
07/08/2007
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