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General NPI Number Information
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NPI Number | 1306217773
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Entity Type | Individual
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Provider Name | ORBIE OTTEY JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 2702 WILMA RUDOLPH BLVD
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City | CLARKSVILLE
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State | TN
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Zip | 37040-6299
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Country | US
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Telephone | 931-542-4759
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Fax |
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Provider Business Mailing Address
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Address Line | 113 WATTS CIR
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City | NASHVILLE
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State | TN
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Zip | 37209-4410
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Country | US
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Telephone | 702-526-7478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10166
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License Number State | TN
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