Provider Demographics
NPI:1851901755
Name:OTTESON, CHRISTIAN J (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:J
Last Name:OTTESON
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 1:2632 SUNDAY GRACE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2842
Mailing Address - Country:US
Mailing Address - Phone:480-772-6884
Mailing Address - Fax:
Practice Address - Street 1:5061 E SAHARA AVE STE 1A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-2986
Practice Address - Country:US
Practice Address - Phone:702-641-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV73661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice