1851683510 NPI number — MRS. GENEVIEVE MARIE OTTO DDS, MSD

Table of content: MRS. GENEVIEVE MARIE OTTO DDS, MSD (NPI 1851683510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851683510 NPI number — MRS. GENEVIEVE MARIE OTTO DDS, MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTO
Provider First Name:
GENEVIEVE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OTTO
Provider Other First Name:
GENEVIEVE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851683510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 SCHROEDER CREEK BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENTZVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63385-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-900-6886
Provider Business Mailing Address Fax Number:
636-887-3694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12360 MANCHESTER RD.
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
DES PERES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-900-6886
Provider Business Practice Location Address Fax Number:
636-887-3694
Provider Enumeration Date:
05/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2010040607 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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