Provider Demographics
NPI:1487493813
Name:OTANES, STEPHEN ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALLEN
Last Name:OTANES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SPINNING AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2580
Mailing Address - Country:US
Mailing Address - Phone:407-637-1945
Mailing Address - Fax:
Practice Address - Street 1:1055 JABARA AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27531-2311
Practice Address - Country:US
Practice Address - Phone:919-722-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0134278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist