Provider Demographics
NPI:1821183419
Name:OTERO, HARALDO J (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARALDO
Middle Name:J
Last Name:OTERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 N. ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-896-7583
Mailing Address - Fax:407-894-7202
Practice Address - Street 1:1200 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2116
Practice Address - Country:US
Practice Address - Phone:407-896-7583
Practice Address - Fax:407-894-7202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL136841223G0001X
FLDN136841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice