Provider Demographics
NPI:1437160686
Name:OTERO, ERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:
Last Name:OTERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CARR 2 STE 302
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6064
Mailing Address - Country:US
Mailing Address - Phone:787-883-6234
Mailing Address - Fax:787-883-1323
Practice Address - Street 1:36 CARR 2 STE 302
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6064
Practice Address - Country:US
Practice Address - Phone:787-883-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice