Active NPI
Douglas Wade Otopalik, DDS
- General Practice Dentistry
- Mankato, MN
National Provider Identifier
1477537637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10057
- Practice address
- 111 Star St
Suite 109
Mankato, MN 56001-4888 - Phone
- (507) 387-3249
- Fax
- (507) 387-7175
- NPI assigned
- Dec 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10057 | MN | Primary |
Addresses
Primary practice location
111 Star St
Suite 109
Mankato, MN 56001-4888
Mailing address
127 Red Oak Dr
Mankato, MN 56001-8996
Phone (507) 317-2291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 299220500 | Other | MN | MEDICAL ASSISTANCE PROV # |
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 |
|---|---|---|---|
| 10057 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1477537637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 RED OAK DR",
"city": "MANKATO",
"state": "MN",
"postal_code": "560018996",
"telephone_number": "507-317-2291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 STAR ST",
"address_2": "SUITE 109",
"city": "MANKATO",
"state": "MN",
"postal_code": "560014888",
"telephone_number": "507-387-3249",
"fax_number": "507-387-7175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTOPALIK",
"first_name": "DOUGLAS",
"middle_name": "WADE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-01",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "10057",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE PROV #",
"identifier": "299220500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.