Provider Demographics
NPI:1497984785
Name:ORTIZ, RICARDO M (DMD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:M
Last Name: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 1:3665 COOLIDGE CT STE 102
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7894
Mailing Address - Country:US
Mailing Address - Phone:850-431-6725
Mailing Address - Fax:850-431-6859
Practice Address - Street 1:3665 COOLIDGE CT STE 102
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7894
Practice Address - Country:US
Practice Address - Phone:850-431-6725
Practice Address - Fax:850-431-6859
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAD-10615204E00000X
FLDN230641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery