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General NPI Number Information
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NPI Number | 1275829368
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Entity Type | Organization
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Legal Business Name | ORLY DENTAL PC
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 4935 W COMMERCE ST
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City | SAN ANTONIO
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State | TX
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Zip | 78237-1508
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Country | US
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Telephone | 210-438-0700
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Fax | 210-438-0701
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Provider Business Mailing Address
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Address Line | 4935 W COMMERCE ST
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City | SAN ANTONIO
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State | TX
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Zip | 78237-1508
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Country | US
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Telephone | 210-438-0700
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Fax | 210-438-0701
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ORLANDO ORTIZ JR.
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Credential | DDS
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Telephone | 281-857-2961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18773
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License Number State | TX
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