Healthcare Provider Details

I. General information

NPI: 1952465460
Provider Name (Legal Business Name): JOHN STEPHEN HOTTENSTEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST & PEACH STS
LEESPORTS PA
19533
US

IV. Provider business mailing address

PO BOX 724
LEESPORT PA
19533
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-5705
  • Fax: 610-926-6446
Mailing address:
  • Phone: 610-926-5705
  • Fax: 610-926-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS021247L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: