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General NPI Number Information
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NPI Number | 1366538571
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Entity Type | Organization
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Legal Business Name | ORTIZ & MOSS DENTAL ASSOCIATES, P.C
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2101 TRINITY DR STE P
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City | LOS ALAMOS
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State | NM
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Zip | 87544-4103
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Country | US
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Telephone | 505-662-2426
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 TRINITY DR STE P
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City | LOS ALAMOS
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State | NM
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Zip | 87544-4103
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Country | US
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Telephone | 505-662-2426
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Fax |
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Authorized Official
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Title or Position | CORP. PRESIDENT
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Name | DR. NEREIDA ORTIZ
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Credential | D.D.S
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Telephone | 505-662-2426
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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 | 1700
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License Number State | NM
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