Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 202183 | CO |
Y | 1223P0221X | Pediatric Dentist | 31521 | TX |
NPI | 1043552029 |
---|---|
Provider Name | Dr. Alexandra Barton Otto |
First Address | Buda, TX 78610 |
Second Address | Buda, TX 78610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2013 |
Last Update Date | 23/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3507097 | (05) | TX |