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NPI Code Detail

MEDICARE: DR. ALFRED NMN OTERO JR. DDS

MEDICARE: DR. ALFRED NMN OTERO JR. DDS
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
11223G0001XGeneral Practice DentistryDD2011NM

General Provider Information

NPI Number : 1841271335
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALFRED NMN OTERO JR. DDS
Provider Business Mailing Address
First Line : 6401 S RICHARDS AVE
Second Line :
City : SANTA FE
State : NM
Zip : 87508-4887
Country : US
Telephone Number : 505-428-1710
Fax Number : 505-428-1511
Provider Business Practice Location Address
First Line : 6401 S RICHARDS AVE
Second Line :
City : SANTA FE
State : NM
Zip : 87508-4887
Country : US
Telephone Number : 505-428-1710
Fax Number : 505-428-1511
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 07/08/2007

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