Provider Demographics
NPI:1700923398
Name:OTIS, LINDA LOUISE (DDS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:OTIS
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 1:1021 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1803
Mailing Address - Country:US
Mailing Address - Phone:402-476-1640
Mailing Address - Fax:402-476-1670
Practice Address - Street 1:1021 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1803
Practice Address - Country:US
Practice Address - Phone:402-476-1640
Practice Address - Fax:402-476-1670
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6452122300000X
NE5236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist