Provider Demographics
NPI:1215463427
Name:SANDRA L. OTIPOBY DDS
Entity type:Organization
Organization Name:SANDRA L. OTIPOBY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OTIPOBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-448-2487
Mailing Address - Street 1:121 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1401
Mailing Address - Country:US
Mailing Address - Phone:785-448-2487
Mailing Address - Fax:785-448-6863
Practice Address - Street 1:121 WEST 6TH AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032
Practice Address - Country:US
Practice Address - Phone:785-448-2487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty