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General NPI Number Information
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NPI Number | 1548394505
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Entity Type | Individual
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Provider Name | GREG A ORTMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 1530 KOSSUTH ST
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City | LAFAYETTE
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State | IN
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Zip | 47905-1561
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Country | US
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Telephone | 765-447-0322
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Fax | 765-447-5731
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Provider Business Mailing Address
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Address Line | 740 DUNBAR CT
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City | LAFAYETTE
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State | IN
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Zip | 47905-8799
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Country | US
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Telephone | 765-448-3302
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12008716A
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License Number State | IN
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