Healthcare Provider Details

I. General information

NPI: 1295577583
Provider Name (Legal Business Name): ZACHARY MICHAEL ORTINAU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 S ARROWHEAD DR STE 300
INDEPENDENCE MO
64055-7018
US

IV. Provider business mailing address

4911 S ARROWHEAD DR STE 300
INDEPENDENCE MO
64055-7018
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2024020959
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: