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General NPI Number Information
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NPI Number | 1700111994
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Entity Type | Organization
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Legal Business Name | OTTO AND KOTECKI FAMILY DENTISTRY PLC
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 24 S HAWKEYE
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City | NORA SPRINGS
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State | IA
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Zip | 50458-7703
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Country | US
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Telephone | 641-749-5430
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Fax | 641-749-5779
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Provider Business Mailing Address
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Address Line | 24 S HAWKEYE
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City | NORA SPRINGS
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State | IA
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Zip | 50458-7703
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Country | US
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Telephone | 641-749-5430
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Fax | 641-749-5779
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Authorized Official
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Title or Position | PRACTICE COORDINATOR
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Name | MRS. JERALYN G. HUISMAN
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Credential |
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Telephone | 641-424-6461
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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 | 06834
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08654
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08229
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License Number State | IA
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