Provider Demographics
NPI:1982049011
Name:OTERO ENTERPRISES
Entity Type:Organization
Organization Name:OTERO ENTERPRISES
Other - Org Name:EMERGENCY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-736-0831
Mailing Address - Street 1:220 S 16TH ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:215-545-2600
Mailing Address - Fax:215-545-4107
Practice Address - Street 1:220 S 16TH ST
Practice Address - Street 2:SUITE 901
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3322
Practice Address - Country:US
Practice Address - Phone:215-545-2600
Practice Address - Fax:215-545-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty