Provider Demographics
NPI:1922364439
Name:OTERO-RODRIGUEZ, ARIEL O (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:O
Last Name:OTERO-RODRIGUEZ
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 1:221 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2437
Mailing Address - Country:US
Mailing Address - Phone:201-299-6393
Mailing Address - Fax:201-299-6394
Practice Address - Street 1:221 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2437
Practice Address - Country:US
Practice Address - Phone:201-299-6393
Practice Address - Fax:201-299-6394
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027549001223S0112X
PR31771223S0112X
NY0590891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery