Provider Demographics
NPI:1083346944
Name:ORTEGA, NILO (DMD)
Entity Type:Individual
Prefix:
First Name:NILO
Middle Name:
Last Name:ORTEGA
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 1:11830 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3616
Mailing Address - Country:US
Mailing Address - Phone:727-288-3938
Mailing Address - Fax:
Practice Address - Street 1:11830 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3616
Practice Address - Country:US
Practice Address - Phone:727-288-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN268841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice