Provider Demographics
NPI:1336299296
Name:OTTINGER, PHILIP LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LANE
Last Name:OTTINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1714
Mailing Address - Country:US
Mailing Address - Phone:831-476-1500
Mailing Address - Fax:831-476-1501
Practice Address - Street 1:1588 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1714
Practice Address - Country:US
Practice Address - Phone:831-476-1500
Practice Address - Fax:831-476-1501
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice