Provider Demographics
NPI:1346303393
Name:KITTLE, OTIS BAYERD (DDS)
Entity Type:Individual
Prefix:MR
First Name:OTIS
Middle Name:BAYERD
Last Name:KITTLE
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 1:415 ALTURAS STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-671-2080
Mailing Address - Fax:530-671-1159
Practice Address - Street 1:415 ALTURAS STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-671-2080
Practice Address - Fax:530-671-1159
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist