Provider Demographics
NPI:1255328688
Name:OETTMEIER, BERT WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:WILLIAM
Last Name:OETTMEIER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4501 COLLEGE BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1761
Mailing Address - Country:US
Mailing Address - Phone:913-491-6553
Mailing Address - Fax:913-491-6559
Practice Address - Street 1:4501 COLLEGE BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1761
Practice Address - Country:US
Practice Address - Phone:913-491-6553
Practice Address - Fax:913-491-6559
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS54191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice