Provider Demographics
NPI:1376540013
Name:ORTIZ CLASS, RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:ORTIZ CLASS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ORTIZ
Other - Middle Name:CLASS
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:AVE ROBERTO CLEMENTE
Mailing Address - Street 2:24 8 VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5401
Mailing Address - Country:US
Mailing Address - Phone:787-757-3080
Mailing Address - Fax:787-757-1910
Practice Address - Street 1:ROBERTO CLEMENTE AVE
Practice Address - Street 2:24 8 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5401
Practice Address - Country:US
Practice Address - Phone:787-757-3080
Practice Address - Fax:787-757-1910
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-11-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
PR25231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2523OtherMEDICAL LICENCES