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General NPI Number Information
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NPI Number | 1689164782
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Entity Type | Individual
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Provider Name | JOSE ORLANDO MALDONADO-ORTIZ DDS, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 450 SYNDICATE ST N
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City | SAINT PAUL
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State | MN
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Zip | 55104-4107
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Country | US
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Telephone | 651-254-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 13910 EMBER WAY
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City | APPLE VALLEY
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State | MN
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Zip | 55124-9247
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Country | US
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Telephone | 787-557-6769
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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 | D13988
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License Number State | MN
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