Provider Demographics
NPI:1063820322
Name:OTTO, PAMELA I (DDS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:OTTO
Suffix:I
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 YORK RD
Mailing Address - Street 2:SUITE212
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6097
Mailing Address - Country:US
Mailing Address - Phone:410-337-8200
Mailing Address - Fax:410-337-9026
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE212
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-337-8200
Practice Address - Fax:410-337-9026
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist