Provider Demographics
NPI:1467553669
Name:ORTIZ DE LA RENTA, JUAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:ORTIZ DE LA RENTA
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:PO BOX 8480
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0480
Mailing Address - Country:US
Mailing Address - Phone:787-776-0570
Mailing Address - Fax:
Practice Address - Street 1:VIA MIRTA 3 DS-1
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-776-0570
Practice Address - Fax:787-776-0570
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice