Provider Demographics
NPI:1700111994
Name:OTTO AND KOTECKI FAMILY DENTISTRY PLC
Entity Type:Organization
Organization Name:OTTO AND KOTECKI FAMILY DENTISTRY PLC
Other - Org Name:WEBER AND OTTO FAMILY DENTISTRY PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERALYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-424-6461
Mailing Address - Street 1:24 S HAWKEYE
Mailing Address - Street 2:
Mailing Address - City:NORA SPRINGS
Mailing Address - State:IA
Mailing Address - Zip Code:50458-7703
Mailing Address - Country:US
Mailing Address - Phone:641-749-5430
Mailing Address - Fax:641-749-5779
Practice Address - Street 1:24 S HAWKEYE
Practice Address - Street 2:
Practice Address - City:NORA SPRINGS
Practice Address - State:IA
Practice Address - Zip Code:50458-7703
Practice Address - Country:US
Practice Address - Phone:641-749-5430
Practice Address - Fax:641-749-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06834122300000X
IA08654122300000X
IA08229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty