Otte, Larry D

Otte, Larry D is an individual health care provider with primary practice located at 2807 N Knoxville Ave , Peoria IL 61604-2869. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Oral and Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Otte, Larry D can be contacted via phone (309) 682-1213.

Contact Information

Primary practice address
2807 N Knoxville Ave Peoria IL 61604-2869
Phone: (309) 682-1213
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 019-024407 Illinois
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 021-001850 Illinois

Profile Details

NPI number 1194859355
LBN Legal business name Otte, Larry D
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2007
Last updated Oct 2nd, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1194859355 NPPES
Illinois Other 909830 MEDICARE PT10

Popular Providers