Provider Demographics
NPI:1457497901
Name:ORTEGO, L. STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:STEPHEN
Last Name:ORTEGO
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 1:5813 MONROE HWY
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3362
Mailing Address - Country:US
Mailing Address - Phone:318-640-1470
Mailing Address - Fax:318-640-4700
Practice Address - Street 1:5813 MONROE HWY
Practice Address - Street 2:
Practice Address - City:BALL
Practice Address - State:LA
Practice Address - Zip Code:71405-3362
Practice Address - Country:US
Practice Address - Phone:318-640-1470
Practice Address - Fax:318-640-4700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1839965Medicaid