Provider Demographics
NPI:1578627212
Name:ORTIZ, JUDITH (RDH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
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:US ARMY HOSPITAL HDENTAC CREDENTIALS OFFICE
Mailing Address - Street 2:KARLSUHERSTR 144 NACHRICTEN KASERNE BLDG 3607
Mailing Address - City:HEIDELBERG
Mailing Address - State:BADEN WURTEMBOURG
Mailing Address - Zip Code:69126
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY HOSPITAL HDENTAC CREDENTIALS OFFICE
Practice Address - Street 2:KARLSUHERSTR 144 NACHRICTEN KASERNE BLDG 3607
Practice Address - City:HEIDELBERG
Practice Address - State:BADEN WURTEMBOURG
Practice Address - Zip Code:69126
Practice Address - Country:DE
Practice Address - Phone:01149622-117-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH009005124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist