Provider Demographics
NPI:1114091790
Name:ROBERT F. OTTO D.M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT F. OTTO D.M.D., P.C.
Other - Org Name:OSWEGO DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-554-9100
Mailing Address - Street 1:21 W. JEFFERSON ST.
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9002
Mailing Address - Country:US
Mailing Address - Phone:630-554-9100
Mailing Address - Fax:630-554-1809
Practice Address - Street 1:21 W. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9002
Practice Address - Country:US
Practice Address - Phone:630-554-9100
Practice Address - Fax:630-554-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty