Lisa Rae Otoude, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

32631 Issued in TX

Practice address

275 N NC 16 Business Hwy Ste 204B
Denver, NC 28037-3000

Phone

(704) 275-5556

NPI assigned

Jun 16, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The University of Texas Health Science Center at Houston

  • Pediatric Dentistry
  • Houston, TX
  • NPI 1154745651

  General Practice

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1124432349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14928 NICHOLS HALL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282737504",
            "telephone_number": "919-360-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 N NC 16 BUSINESS HWY STE 204B",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280373000",
            "telephone_number": "704-275-5556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9055 Cresswind Blvd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282152272",
            "country_code": "US",
            "telephone_number": "704-350-2152",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5708 N Sharon Amity Rd Ste 5708-A",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282155082",
            "country_code": "US",
            "telephone_number": "704-350-2153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTOUDE",
        "first_name": "LISA",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-16",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "10960",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "32631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX9605",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Sarah O'Brien, OD
• Kellie Harney O'Hara, FNP
• Orthocarolina, PA
• Elisabeth Danielle Ortiz
• Carolyn Ortner
• Sabryna Kelsey Davis Owens, OD
• Pain MD LLC
• Joshua Coleman Pannell, DC
• Gary Lee Patrick, PH.D.
• Kristen Lynne Pawlowski, FNP-C

• General Practice Dentistry in Denver, NC
• Providers in Denver, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.