Provider Demographics
NPI:1083619720
Name:ORTIZ, ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAIN DR
Mailing Address - Street 2:STE 1120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1356
Mailing Address - Country:US
Mailing Address - Phone:915-533-0114
Mailing Address - Fax:915-533-0338
Practice Address - Street 1:300 E MAIN DR
Practice Address - Street 2:STE 1120
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1356
Practice Address - Country:US
Practice Address - Phone:915-533-0114
Practice Address - Fax:915-533-0338
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice