MEDICARE: MICHAEL D. OTTO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	08229	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144342700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D. OTTO DDS

Provider Business Mailing Address
First Line	:	30 BURR OAK LN
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-1400
Country	:	US
Telephone Number	:	641-423-6675
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 4TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-1583
Country	:	US
Telephone Number	:	641-424-6461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/09/2007

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