Healthcare Provider Details

I. General information

NPI: 1568207421
Provider Name (Legal Business Name): KATHLENE OETTER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559
US

IV. Provider business mailing address

PO BOX 528
BETHEL AK
99559
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6603
  • Fax:
Mailing address:
  • Phone: 623-695-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number225216
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: