Healthcare Provider Details

I. General information

NPI: 1588672752
Provider Name (Legal Business Name): ANN L ORTEGA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 SARA RD SE
RIO RANCHO NM
87124-1862
US

IV. Provider business mailing address

1594 SARA RD SE
RIO RANCHO NM
87124-1862
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-2200
  • Fax: 505-896-2300
Mailing address:
  • Phone: 505-896-2200
  • Fax: 505-896-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1662
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: