Provider Demographics
NPI:1942463781
Name:OTTO, MILTON JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:JOSEPH
Last Name:OTTO
Suffix:
Gender:M
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-0337
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice