Healthcare Provider Details

I. General information

NPI: 1912251240
Provider Name (Legal Business Name): REBECCA OTTEN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N BUSINESS HWY 71
ANDERSON MO
64831
US

IV. Provider business mailing address

4301 DONIPHAN DR
NEOSHO MO
64850-9120
US

V. Phone/Fax

Practice location:
  • Phone: 417-845-2273
  • Fax:
Mailing address:
  • Phone: 417-451-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10478
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: