Provider Demographics
NPI:1629082748
Name:BOTTI, MICHELE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:BOTTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MARKET PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342
Mailing Address - Country:US
Mailing Address - Phone:937-433-5133
Mailing Address - Fax:937-433-9984
Practice Address - Street 1:9100 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4671
Practice Address - Country:US
Practice Address - Phone:937-433-5133
Practice Address - Fax:937-433-9984
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300214991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30021499OtherLICENSE #