Healthcare Provider Details

I. General information

NPI: 1235187162
Provider Name (Legal Business Name): NORMAN WILLIAM OTT JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE
APO AE
09180
US

IV. Provider business mailing address

CMR 402 LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 637-192-9130
  • Fax:
Mailing address:
  • Phone: 637-192-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5527
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: