Healthcare Provider Details

I. General information

NPI: 1194878462
Provider Name (Legal Business Name): ROBERT ORTA DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W DR MARTIN LUTHER KING JR BLVD STE 2
TAMPA FL
33603
US

IV. Provider business mailing address

801 W DR MARTIN LUTHER KING JR BLVD STE 2
TAMPA FL
33603
US

V. Phone/Fax

Practice location:
  • Phone: 813-238-0411
  • Fax: 813-238-5341
Mailing address:
  • Phone: 813-238-0411
  • Fax: 813-238-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN14351
License Number StateFL

VIII. Authorized Official

Name: ROBERT ORTA
Title or Position: OWNER
Credential: DDS PA
Phone: 813-238-0411