Provider Demographics
NPI:1922154202
Name:OTERO, ANGEL MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MANUEL
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:J4 CALLE RUISENOR
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3345
Mailing Address - Country:US
Mailing Address - Phone:787-758-0243
Mailing Address - Fax:787-282-8755
Practice Address - Street 1:FDR 525
Practice Address - Street 2:SUITE 611
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-0243
Practice Address - Fax:787-282-8755
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist