Healthcare Provider Details

I. General information

NPI: 1134447113
Provider Name (Legal Business Name): OTT DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 WORTH PARK
CHARLOTTESVILLE VA
22911-7441
US

IV. Provider business mailing address

1769 WORTH PARK
CHARLOTTESVILLE VA
22911-7441
US

V. Phone/Fax

Practice location:
  • Phone: 434-964-0088
  • Fax: 434-973-6616
Mailing address:
  • Phone: 434-964-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412745
License Number StateVA

VIII. Authorized Official

Name: DR. SARAH LYNN OTT
Title or Position: DENTIST
Credential: DMD
Phone: 623-687-1157