Provider Demographics
NPI:1477891083
Name:ORNELAS, GILBERTO JR (RDH)
Entity Type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:
Last Name:ORNELAS
Suffix:JR
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 CENTRAL AVE SE APT 167
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4004
Mailing Address - Country:US
Mailing Address - Phone:505-453-5299
Mailing Address - Fax:
Practice Address - Street 1:2118 CENTRAL AVE SE APT 167
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4004
Practice Address - Country:US
Practice Address - Phone:505-453-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3816124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist