Provider Demographics
NPI:1306159108
Name:OTT, ERICH CHRISTOFFER (DMD)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:CHRISTOFFER
Last Name:OTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 PEGER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5256
Mailing Address - Country:US
Mailing Address - Phone:907-452-7007
Mailing Address - Fax:
Practice Address - Street 1:1870 PEGER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5256
Practice Address - Country:US
Practice Address - Phone:907-452-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist