MEDICARE: DR. NICOLAS ORTA DMD

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	17823	FL

General Provider Information

NPI Number	:	1346456175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS ORTA DMD

Provider Business Mailing Address
First Line	:	2518 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4817
Country	:	US
Telephone Number	:	954-454-2504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4817
Country	:	US
Telephone Number	:	954-454-2504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	03/02/2015

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