Provider Demographics
NPI:1659393783
Name:OTTAVI, ALICE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:M
Last Name:OTTAVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2232 HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2737
Mailing Address - Country:US
Mailing Address - Phone:612-377-6108
Mailing Address - Fax:612-374-1820
Practice Address - Street 1:2232 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2737
Practice Address - Country:US
Practice Address - Phone:612-377-6108
Practice Address - Fax:612-374-1820
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN99191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN978483OtherUNITED CONCORDIA
MN0015210OtherDORAL DENTAL
MN1727OtherHEALTH PARTNERS
MN46092 DEOtherBLUE CROSS BLUE SHIELD