Provider Demographics
NPI:1811609415
Name:OTTERSLAND, ERIN E (SA0002989)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:OTTERSLAND
Suffix:
Gender:F
Credentials:SA0002989
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 CARIBOU DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4330
Mailing Address - Country:US
Mailing Address - Phone:970-225-9555
Mailing Address - Fax:
Practice Address - Street 1:2014 CARIBOU DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4330
Practice Address - Country:US
Practice Address - Phone:970-225-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0002989126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSA.0002989OtherDA