| Otter Kids Pediatric Dentistry Pllc | |
|
1155 Kelly Johnson Blvd Ste 210 Colorado Springs CO 80920 | |
| (719) 867-0550 | |
| (719) 867-3191 |
| Full Name | Otter Kids Pediatric Dentistry Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1155 Kelly Johnson Blvd, Colorado Springs, Colorado |
| Authorized Official Name and Position | Kenneth John Otterstedt (OWNER) |
| Authorized Official Contact | 7198675500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Otter Kids Pediatric Dentistry Pllc 1294 Oakmont Dr Colorado Springs CO 80921-3762 Ph: (719) 867-0550 | Otter Kids Pediatric Dentistry Pllc 1155 Kelly Johnson Blvd Ste 210 Colorado Springs CO 80920 Ph: (719) 867-0550 |
| NPI Number | 1588486575 |
|---|---|
| Provider Enumeration Date | 10/30/2024 |
| Last Update Date | 10/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588486575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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Premier Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 685 Citadel Dr E, Suite 302, Colorado Springs, CO 80909 Phone: 719-596-1011 Fax: 719-596-6748 |