Provider Demographics
NPI:1609880293
Name:OTTO, WILLIAM RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RALPH
Last Name:OTTO
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 1:131 W MONROE AVE
Mailing Address - Street 2:7
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5814
Mailing Address - Country:US
Mailing Address - Phone:314-965-3646
Mailing Address - Fax:
Practice Address - Street 1:131 W MONROE AVE
Practice Address - Street 2:7
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5814
Practice Address - Country:US
Practice Address - Phone:314-965-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist