Provider Demographics
NPI:1336120997
Name:ROMAN-ORTIZ, VICTOR MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:ROMAN-ORTIZ
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:HC 1 BOX 9732
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-9786
Mailing Address - Country:US
Mailing Address - Phone:787-995-4700
Mailing Address - Fax:787-995-4700
Practice Address - Street 1:HC 1 BOX 9732
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-9786
Practice Address - Country:US
Practice Address - Phone:787-995-4700
Practice Address - Fax:787-995-4700
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0020691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice