Provider Demographics
NPI:1578233888
Name:DE OLIVEIRA OTT, ANA PAULA (DMD)
Entity Type:Individual
Prefix:
First Name:ANA PAULA
Middle Name:
Last Name:DE OLIVEIRA OTT
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 1:6230 GOLDEN DEWDROP TRL
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5697
Mailing Address - Country:US
Mailing Address - Phone:407-961-3722
Mailing Address - Fax:
Practice Address - Street 1:6429 RALEIGH STREET
Practice Address - Street 2:METROWEST
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5739
Practice Address - Country:US
Practice Address - Phone:407-743-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL259841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice