Provider Demographics
NPI:1629036744
Name:OTERO, ANGEL M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
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 1:47 CALLE 1
Mailing Address - Street 2:HERMANAS DAVILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8023
Mailing Address - Country:US
Mailing Address - Phone:787-786-8540
Mailing Address - Fax:787-995-0431
Practice Address - Street 1:47 CALLE 1
Practice Address - Street 2:HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-8023
Practice Address - Country:US
Practice Address - Phone:787-786-8540
Practice Address - Fax:787-995-0431
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery