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General NPI Number Information
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NPI Number | 1659433779
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Entity Type | Individual
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Provider Name | JOSE ANIBAL ORTIZ D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | URB. ORTA, CARR 14 KM 13.1
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City | JUANA DIAZ
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State | PR
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Zip | 00795
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Country | US
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Telephone | 787-837-1414
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Fax | 787-837-1414
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Provider Business Mailing Address
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Address Line | URB. CARRION MADURO 3 CALLE 1
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City | JUANA DIAZ
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State | PR
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Zip | 00795
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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 |
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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 | 2142
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License Number State | PR
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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 | DN15853
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License Number State | FL
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