Healthcare Provider Details

I. General information

NPI: 1083671630
Provider Name (Legal Business Name): JOHANA ORTIZ APONTE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 30 ALTOS LA PLAZOLETA PLAZA CAROLINA MALL
CAROLINA PR
00988
US

IV. Provider business mailing address

PO BOX 8761 PLAZA CAROLINA STATION
CAROLINA PR
00988-8761
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-7988
  • Fax: 787-769-7340
Mailing address:
  • Phone: 787-757-7988
  • Fax: 787-769-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2034
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: