Provider Demographics
NPI:1942288204
Name:OTIPOBY, SANDI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDI
Middle Name:
Last Name:OTIPOBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1316
Mailing Address - Country:US
Mailing Address - Phone:785-448-2487
Mailing Address - Fax:785-448-6863
Practice Address - Street 1:240 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1316
Practice Address - Country:US
Practice Address - Phone:785-448-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice