MEDICARE: DR RAMON F ORTIZ DMDMS PA

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	:	1902350218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR RAMON F ORTIZ DMDMS PA

Provider Business Mailing Address
First Line	:	301 WOODLANDS PKWY
Second Line	:	SUITE 6
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2033
Country	:	US
Telephone Number	:	727-784-0929
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 WOODLANDS PKWY
Second Line	:	SUITE 6
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2033
Country	:	US
Telephone Number	:	727-784-0929
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAMON F ORTIZ
Credential	:
Telephone Number	:	727-784-0929

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	08/05/2016

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