Provider Demographics
NPI:1538112669
Name:ORTMAN, MICHAEL LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEWIS
Last Name:ORTMAN
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 1:4224 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1924
Mailing Address - Country:US
Mailing Address - Phone:937-276-3172
Mailing Address - Fax:937-276-3318
Practice Address - Street 1:4224 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1924
Practice Address - Country:US
Practice Address - Phone:937-276-3172
Practice Address - Fax:937-276-3318
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH179621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice