Dana Eric Otterholt, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4962 Issued in WA

Practice address

104 N 15TH St
Mount Vernon, WA 98273-3405

Phone

(360) 424-9045

NPI assigned

Jun 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457399271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 RIDGE WAY",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982739452",
            "telephone_number": "360-424-8804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N 15TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982733405",
            "telephone_number": "360-424-9045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTERHOLT",
        "first_name": "DANA",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "4962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Teresa Ortiz-Cassity, LMHC
• Allison Osborne, MSW, LICSW, SUDP
• Victoria Lynn Osborne, PHARM-D
• Sharon A. Osea, MD
• Alina Yakivna Ostapchuk, ARNP
• Victoria Tucker Otterholt, D.D.S.
• Otterson Counseling PS
• Elizabeth Ann Otterson, MSW, LICSW
• Todd R Ouellette, ARNP
• Deborah Suzanne Owens, ARNP

• General Practice Dentistry in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.