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General NPI Number Information
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NPI Number | 1851683510
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Entity Type | Individual
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Provider Name | GENEVIEVE MARIE OTTO DDS, MSD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 12360 MANCHESTER RD. STE 204
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City | DES PERES
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State | MO
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Zip | 63131-4302
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Country | US
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Telephone | 314-900-6886
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Fax | 636-887-3694
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Provider Business Mailing Address
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Address Line | 1002 SCHROEDER CREEK BLVD.
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City | WENTZVILLE
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State | MO
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Zip | 63385-3558
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Country | US
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Telephone | 314-900-6886
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Fax | 636-887-3694
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2010040607
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License Number State | MO
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