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General NPI Number Information
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NPI Number | 1831108760
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Entity Type | Organization
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Legal Business Name | MILTON J OTTO DDS
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 915 FM 1626
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City | MANCHACA
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State | TX
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Zip | 78652
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Country | US
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Telephone | 512-282-0625
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Fax | 512-282-6447
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Provider Business Mailing Address
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Address Line | PO BOX 337 915 FM 1626
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City | MANCHACA
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State | TX
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Zip | 78652
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Country | US
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Telephone | 512-282-0625
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Fax | 512-282-6447
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MILTON JOSEPH OTTO
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Credential | DDS
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Telephone | 512-282-0625
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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 | 10342
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License Number State | TX
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