Provider Demographics
NPI:1356705628
Name:OTTLEY FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:OTTLEY FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:OTTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-438-7064
Mailing Address - Street 1:309 MARKET ST E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3023
Mailing Address - Country:US
Mailing Address - Phone:931-438-7064
Mailing Address - Fax:931-438-7066
Practice Address - Street 1:309 MARKET ST E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3023
Practice Address - Country:US
Practice Address - Phone:931-438-7064
Practice Address - Fax:931-438-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty