Provider Demographics
NPI:1528104312
Name:DR CESAR OTERO DDS PC
Entity type:Organization
Organization Name:DR CESAR OTERO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-228-0120
Mailing Address - Street 1:1197 WINDHAM LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7245
Mailing Address - Country:US
Mailing Address - Phone:847-891-1148
Mailing Address - Fax:
Practice Address - Street 1:60 TURNER AVE
Practice Address - Street 2:LOWER LEVEL WEST
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3956
Practice Address - Country:US
Practice Address - Phone:847-228-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL105150Medicaid