Provider Demographics
NPI:1811006992
Name:OTI, JORGE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:OTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CATRON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1806
Mailing Address - Country:US
Mailing Address - Phone:505-986-0606
Mailing Address - Fax:505-986-0202
Practice Address - Street 1:312 CATRON ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1806
Practice Address - Country:US
Practice Address - Phone:505-986-0606
Practice Address - Fax:505-986-0202
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice