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General NPI Number Information
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NPI Number | 1043362585
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Entity Type | Organization
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Legal Business Name | JOSE A ORTIZ DMD PL
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/26/2009
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Provider Practice Location Address
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Address Line | 7244 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32818-6749
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Country | US
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Telephone | 407-299-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 ESTANCIA CIR
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City | KISSIMMEE
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State | FL
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Zip | 34741-6381
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Country | US
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Telephone | 352-978-2413
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JOSE ANIBAL ORTIZ
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Credential | DMD
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Telephone | 352-978-2413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN15853
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License Number State | FL
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