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1366804189 NPI number — ELIZABETH SARAH OTT DDS

NPI Number: 1366804189
Health Care Provider/Practitioner: ELIZABETH SARAH OTT DDS

Information about “1366804189” NPI (ELIZABETH SARAH OTT DDS) exists in 1366804189 in HTML format HTML  |  1366804189 in plain Text format TXT  |  1366804189 in PDF (Portable Document Format) PDF  |  1366804189 in an XML format XML  formats.

NPI Number : 1366804189 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366804189",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OTT",
    "FirstName": "ELIZABETH",
    "MiddleName": "SARAH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "UNIVERSITY OF WASHINGTON DEPARTMENT OF ORAL",
    "SecondLineMailingAddress": "1959 NE PACIFIC STREET, BOX 357134",
    "MailingAddressCityName": "SEATTLE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98195-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "121 OAKRIDGE CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERTOWN",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53094-4100",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-261-5110",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/22/2016",
    "LastUpdateDate": "09/27/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "1001514-15",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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