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General NPI Number Information
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NPI Number | 1861577231
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Entity Type | Individual
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Provider Name | DAVID BRUCE OTIS DDS
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 125 N PANSY STREET
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City | ISHPEMING
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State | MI
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Zip | 49849-3015
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Country | US
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Telephone | 906-485-5575
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Fax | 906-485-1260
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Provider Business Mailing Address
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Address Line | 1000 ALLENEZ RD
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-485-5575
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Fax | 906-485-1260
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901016005
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License Number State | MI
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