Healthcare Provider Details

I. General information

NPI: 1982049011
Provider Name (Legal Business Name): OTERO ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 16TH ST SUITE 901
PHILADELPHIA PA
19102-3322
US

IV. Provider business mailing address

220 S 16TH ST SUITE 901
PHILADELPHIA PA
19102
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-2600
  • Fax: 215-545-4107
Mailing address:
  • Phone: 215-545-2600
  • Fax: 215-545-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. ABRAHAM OTERO
Title or Position: OWNER
Credential:
Phone: 267-736-0831