MEDICARE: DR. CESAR RICARDO OTERO 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	122300000X	Dentist	019023335	IL

General Provider Information

NPI Number	:	1982740858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CESAR RICARDO OTERO DDS

Provider Business Mailing Address
First Line	:	1197 WINDHAM LN
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-7245
Country	:	US
Telephone Number	:	847-891-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 TURNER AVE
Second Line	:	LOWER LEVEL WEST
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3956
Country	:	US
Telephone Number	:	847-228-0120
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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