MEDICARE: DR. MICHAEL LEWIS ORTMAN DDS

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	1223G0001X	General Practice Dentistry	17962	OH

General Provider Information

NPI Number	:	1538112669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LEWIS ORTMAN DDS

Provider Business Mailing Address
First Line	:	4224 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1924
Country	:	US
Telephone Number	:	937-276-3172
Fax Number	:	937-276-3318

Provider Business Practice Location Address
First Line	:	4224 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1924
Country	:	US
Telephone Number	:	937-276-3172
Fax Number	:	937-276-3318

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/20/2011

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