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General NPI Number Information
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NPI Number | 1336824796
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Entity Type | Individual
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Provider Name | MONICA MICHELLE BURSIAN ORTIZ DMD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 7200 LAKEVIEW PKWY
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City | ROWLETT
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State | TX
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Zip | 75088-4205
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Country | US
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Telephone | 972-632-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 11829 DUXBURY DR
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City | DALLAS
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State | TX
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Zip | 75218-1848
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Country | US
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Telephone | 321-749-5758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN28074
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40863
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License Number State | TX
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