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General NPI Number Information
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NPI Number | 1366804189
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Entity Type | Individual
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Provider Name | ELIZABETH SARAH OTT DDS
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 121 OAKRIDGE CT
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City | WATERTOWN
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State | WI
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Zip | 53094-4100
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Country | US
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Telephone | 920-261-5110
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Fax |
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Provider Business Mailing Address
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Address Line | UNIVERSITY OF WASHINGTON DEPARTMENT OF ORAL 1959 NE PACIFIC STREET, BOX 357134
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City | SEATTLE
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State | WA
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Zip | 98195-0001
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1001514-15
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License Number State | WI
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