Provider Demographics
NPI:1508411372
Name:ORTEGA, ABRAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABRAM
Middle Name:
Last Name:ORTEGA
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 1:512 PAUL JONES PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2924
Mailing Address - Country:US
Mailing Address - Phone:210-421-6180
Mailing Address - Fax:
Practice Address - Street 1:3909 N IH 35 STE A1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1529
Practice Address - Country:US
Practice Address - Phone:512-458-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353681223G0001X
FLDN264331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice