Otter Kids Pediatric Dentistry PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

OTTER KIDS PEDIATRIC DENTISTRY PLLC

Practice address

1155 Kelly Johnson Blvd
Ste 210
Colorado Springs, CO 80920

Phone

(719) 867-0550

Fax

(719) 867-3191

NPI assigned

Oct 30, 2024

Last updated

Oct 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth John Otterstedt, DDSNPI 1699821181

Title

Owner

Phone

(719) 867-5500

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth J Otterstedt, DDS

  • Pediatric Dentistry
  • Colorado Springs, CO
  • NPI 1699821181
  NPD Authorized official

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1588486575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 OAKMONT DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213762",
            "telephone_number": "719-867-0550",
            "fax_number": "719-867-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 KELLY JOHNSON BLVD",
            "address_2": "STE 210",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80920",
            "telephone_number": "719-867-0550",
            "fax_number": "719-867-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTER KIDS PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "OTTERSTEDT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-867-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Leigh Oswalt, FNP-C
• Bailey Otey
• Monika Otey, LMT
• Christine Ott, PT, DPT
• Michael John Ott, PSY.D.
• Kenneth J Otterstedt, DDS
• Christina Otto
• Connor Katherine Otto, PMHNP-BC
• Kristal Otto, LMHC
• Our Hands, Your Wellness

• Pediatric Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.