Individual
JOHN J OTTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Contact information
Practice address
4014 LEAVENWORTH ST, OMAHA, NE 68105-1053
(402) 559-5999
(402) 559-3499
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019-023700
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
021-001773
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30317
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
909830
MEDICARE PT10
IL
Enumeration date
03/16/2007
Last updated
03/17/2018
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