Provider Demographics
NPI:1831108760
Name:MILTON J OTTO DDS
Entity Type:Organization
Organization Name:MILTON J OTTO DDS
Other - Org Name:MANCHACA DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-282-0625
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:915 FM 1626
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652
Mailing Address - Country:US
Mailing Address - Phone:512-282-0625
Mailing Address - Fax:512-282-6447
Practice Address - Street 1:915 FM 1626
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652
Practice Address - Country:US
Practice Address - Phone:512-282-0625
Practice Address - Fax:512-282-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty