Active NPI
John Ottesen, DDS
- Dentist
- Manchester Center, VT
National Provider Identifier
1316087828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 016.0086821
- Practice address
- 74 Longview Drive
Manchester Center, VT 05255 - Phone
- (315) 761-5366
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 016.0086821 | VT | Primary |
Addresses
Primary practice location
74 Longview Drive
Manchester Center, VT 05255
Mailing address
PO Box 316
Manchester, VT 05254-0316
Phone (315) 280-4370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016.0086821 | VT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mason Dental PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Manchester, VT
- NPI 1306215025
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352073600000",
"number": "1316087828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 316",
"city": "MANCHESTER",
"state": "VT",
"postal_code": "052540316",
"telephone_number": "315-280-4370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 LONGVIEW DRIVE",
"city": "MANCHESTER CENTER",
"state": "VT",
"postal_code": "05255",
"telephone_number": "315-761-5366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTESEN",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2012-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VT",
"license": "016.0086821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester Center, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.