Provider Demographics
NPI:1689846925
Name:WOTTRENG FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:WOTTRENG FAMILY DENTAL, LLC
Other - Org Name:WOTTRENG FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOTTRENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-446-8301
Mailing Address - Street 1:120 LANDMARK DR NE STE 2
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5701
Mailing Address - Country:US
Mailing Address - Phone:507-446-8301
Mailing Address - Fax:507-214-1907
Practice Address - Street 1:120 LANDMARK DR NE STE 2
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5701
Practice Address - Country:US
Practice Address - Phone:507-446-8301
Practice Address - Fax:507-214-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11780261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental