MEDICARE: AFFORDABLE DENTURES - FOREST PARK, WILLIAM SILVESTRY ORTIZ, DMD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1326604604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES - FOREST PARK, WILLIAM SILVESTRY ORTIZ, DMD, INC

Provider Business Mailing Address
First Line	:	1173 SMILEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1832
Country	:	US
Telephone Number	:	513-648-9479
Fax Number	:	513-648-9489

Provider Business Practice Location Address
First Line	:	1173 SMILEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1832
Country	:	US
Telephone Number	:	513-648-9479
Fax Number	:	513-648-9489

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM SILVESTRY-ORTIZ
Credential	:	DMD
Telephone Number	:	513-648-9479

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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