Healthcare Provider Details

I. General information

NPI: 1720242951
Provider Name (Legal Business Name): JUAN ORTIZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV. DE LAS AMERICAS 1267-2
JUAREZ CHIHUAHUA
32300
MX

IV. Provider business mailing address

1120 WILL RAND DR
EL PASO TX
79912-7620
US

V. Phone/Fax

Practice location:
  • Phone: 011526566163100
  • Fax:
Mailing address:
  • Phone: 915-449-8589
  • Fax: 915-833-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number793721
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: