Healthcare Provider Details

I. General information

NPI: 1932849486
Provider Name (Legal Business Name): MARCIO VIEIRA ORTEGOSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 GREENWAY PROFESSIONAL CT
ORLANDO FL
32824-9482
US

IV. Provider business mailing address

110 S WOODLAND ST
WINTER GARDEN FL
34787-3546
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 407-660-1667
Mailing address:
  • Phone: 407-905-8827
  • Fax: 407-660-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN28976
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDRPM2407
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2025004676
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: