Healthcare Provider Details

I. General information

NPI: 1962424739
Provider Name (Legal Business Name): RAMON F ORTIZ DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 BENJAMIN CENTER DR STE 103
TAMPA FL
33634-5262
US

IV. Provider business mailing address

5706 BENJAMIN CENTER DR STE 103
TAMPA FL
33634-5262
US

V. Phone/Fax

Practice location:
  • Phone: 813-288-1999
  • Fax: 813-434-2325
Mailing address:
  • Phone: 813-288-1999
  • Fax: 813-434-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN7873
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN7873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: