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General NPI Number Information
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NPI Number | 1922332303
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Entity Type | Organization
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Legal Business Name | JOSE A ORTIZ DMD, PSC
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | URB. ORTA, CARR. PR-14 #4 LOCAL #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 | 787-903-6579
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Fax |
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Provider Business Mailing Address
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Address Line | 9C9 EXT. DEL CARMEN
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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 | 787-837-4139
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE ANIBAL ORTIZ
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Credential | DMD
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Telephone | 352-978-2413
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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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