Provider Demographics
NPI:1609961077
Name:ORTIZ GONZALEZ, IRIS BELMAR (DMD, MS MPH)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:BELMAR
Last Name:ORTIZ GONZALEZ
Suffix:
Gender:F
Credentials:DMD, MS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 VAN ZANDT ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76905
Mailing Address - Country:US
Mailing Address - Phone:325-651-8536
Mailing Address - Fax:
Practice Address - Street 1:YOKOTA AIR BASE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96326
Practice Address - Country:US
Practice Address - Phone:045-263-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0508461223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice