Provider Demographics
NPI:1932263415
Name:HOTTINGER, JON-ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:JON-ERIC
Middle Name:
Last Name:HOTTINGER
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 1:1624 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4045
Mailing Address - Country:US
Mailing Address - Phone:916-396-2241
Mailing Address - Fax:
Practice Address - Street 1:8450 ELK GROVE BLVD
Practice Address - Street 2:#300
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5964
Practice Address - Country:US
Practice Address - Phone:916-683-8020
Practice Address - Fax:916-683-8025
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2457041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice