Provider Demographics
NPI:1598205213
Name:ORTIZ RIVERA, TANIALIS (DMD)
Entity Type:Individual
Prefix:
First Name:TANIALIS
Middle Name:
Last Name:ORTIZ RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARR 831 CONDOMINIO LA FLORESTA
Mailing Address - Street 2:APARTAMENT 1051
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-366-4016
Mailing Address - Fax:
Practice Address - Street 1:1000 CARR 831 CONDOMINIO LA FLORESTA
Practice Address - Street 2:APARTAMENT 1051
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9736
Practice Address - Country:US
Practice Address - Phone:787-366-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist