MEDICARE: DR CESAR OTERO DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019023335	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528104312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR CESAR OTERO DDS PC

Provider Business Mailing Address
First Line	:	1197 WINDHAM LN
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-7245
Country	:	US
Telephone Number	:	847-891-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 TURNER AVE
Second Line	:	LOWER LEVEL WEST
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3956
Country	:	US
Telephone Number	:	847-228-0120
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CESAR RICARDO OTERO
Credential	:	DDS
Telephone Number	:	847-228-0120

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	04/01/2008

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