Provider Demographics
NPI:1477519528
Name:WOTTRENG, ROBERT VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:WOTTRENG
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 1:120 LANDMARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5700
Mailing Address - Country:US
Mailing Address - Phone:507-446-8301
Mailing Address - Fax:
Practice Address - Street 1:120 LANDMARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5700
Practice Address - Country:US
Practice Address - Phone:507-446-8301
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND117801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice