Provider Demographics
NPI:1093710980
Name:ORTIZ COLON, JUDITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:ORTIZ COLON
Suffix:
Gender:F
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:CALLE ALELI #66 URB FULLANA
Mailing Address - Street 2:EDIF MICHAELANGELO
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-263-8940
Mailing Address - Fax:787-263-7882
Practice Address - Street 1:CALLE ALELI #66 URB FULLANA
Practice Address - Street 2:EDIF MICHAELANGELO PROFESSIONAL CENTRE
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-8940
Practice Address - Fax:787-263-7882
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR42361OtherSSS DENTAL PLAN