Provider Demographics
NPI:1538693353
Name:OTERO, ALEXIS MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MARIE
Last Name:OTERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22950 SW 192ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-5102
Mailing Address - Country:US
Mailing Address - Phone:305-794-1179
Mailing Address - Fax:
Practice Address - Street 1:22950 SW 192ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-5102
Practice Address - Country:US
Practice Address - Phone:305-794-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program