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General NPI Number Information
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NPI Number | 1508316910
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Entity Type | Organization
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Legal Business Name | DRS. OTTOSEN AND NYGARD, PLLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1001 W BROADWAY AVE
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City | MOSES LAKE
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State | WA
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Zip | 98837-2604
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Country | US
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Telephone | 509-766-8968
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Fax | 509-766-8967
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Provider Business Mailing Address
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Address Line | 1001 W BROADWAY AVE
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City | MOSES LAKE
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State | WA
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Zip | 98837-2604
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Country | US
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Telephone | 509-766-8968
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Fax | 509-766-8967
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN R. OTTOSEN
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Credential | DDS, MSD
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Telephone | 509-664-6669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 604-034-843
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License Number State | WA
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