Provider Demographics
NPI:1003269077
Name:ORMAZA, EFREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:
Last Name:ORMAZA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 W CLEVELAND ST
Mailing Address - Street 2:APT 112
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1817
Mailing Address - Country:US
Mailing Address - Phone:423-504-3171
Mailing Address - Fax:
Practice Address - Street 1:5811 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2813
Practice Address - Country:US
Practice Address - Phone:423-504-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist