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General NPI Number Information
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NPI Number | 1942420971
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Entity Type | Individual
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Provider Name | CARLOS ALBERTO ORTIZ D.D.S
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2970 AVE EMILIO FAGOT
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City | PONCE
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State | PR
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Zip | 00716-3615
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Country | US
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Telephone | 787-841-0014
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Fax | 787-841-0015
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Provider Business Mailing Address
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Address Line | 2970 AVE EMILIO FAGOT
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City | PONCE
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State | PR
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Zip | 00716-3615
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Country | US
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Telephone | 787-841-0014
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Fax | 787-841-0015
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1697
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License Number State | PR
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