Healthcare Provider Details

I. General information

NPI: 1306945381
Provider Name (Legal Business Name): PAMELA J ORTIZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 MURPHY RD SUITE 210
MEDFORD OR
97504
US

IV. Provider business mailing address

691 MURPHY RD SUITE 210
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-2625
  • Fax: 541-773-4032
Mailing address:
  • Phone: 541-773-2625
  • Fax: 541-773-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD6756
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: