Provider Demographics
NPI:1679680508
Name:OTT, SARAH L (DMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name: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 1:11414 S 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147
Mailing Address - Country:US
Mailing Address - Phone:623-687-1157
Mailing Address - Fax:
Practice Address - Street 1:2002 VINTON ST
Practice Address - Street 2:VINTON STREET DENTAL
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108
Practice Address - Country:US
Practice Address - Phone:402-341-5306
Practice Address - Fax:402-346-1905
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice