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General NPI Number Information
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NPI Number | 1487493813
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Entity Type | Individual
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Provider Name | STEPHEN ALLEN OTANES DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 1055 JABARA AVE
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City | GOLDSBORO
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State | NC
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Zip | 27531-2311
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Country | US
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Telephone | 919-722-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SPINNING AVE APT 206
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City | CLAYTON
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State | NC
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Zip | 27520-2580
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Country | US
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Telephone | 407-637-1945
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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 | 016.0134278
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License Number State | VT
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