Healthcare Provider Details

I. General information

NPI: 1437244480
Provider Name (Legal Business Name): OTTO AND KOTECKI FAMILY DENTISTRY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 4TH ST SW
MASON CITY IA
50401-1583
US

IV. Provider business mailing address

3223 4TH ST SW
MASON CITY IA
50401-1583
US

V. Phone/Fax

Practice location:
  • Phone: 641-424-6461
  • Fax: 641-424-9186
Mailing address:
  • Phone: 641-424-6461
  • Fax: 641-424-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. JERALYN G. HUISMAN
Title or Position: PRACTICE COORDINATOR
Credential:
Phone: 641-424-6461