Provider Demographics
NPI:1043568595
Name:JOSEPH A. OTTERPOHL, DMD
Entity Type:Organization
Organization Name:JOSEPH A. OTTERPOHL, DMD
Other - Org Name:OTTERPOHL DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTTERPOHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-331-0402
Mailing Address - Street 1:5505 EDMONDSON PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5872
Mailing Address - Country:US
Mailing Address - Phone:615-331-0402
Mailing Address - Fax:615-832-5410
Practice Address - Street 1:5505 EDMONDSON PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5872
Practice Address - Country:US
Practice Address - Phone:615-331-0402
Practice Address - Fax:615-832-5410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH OTTERPOHL, DMD/AMY OTTERPOHL CONNOR DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYDS36871223G0001X
TNDS94971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1619232881OtherNPI
TN1881789568OtherNPI