Provider Demographics
NPI:1609969799
Name:ORTIZ, WANDA I (DDS)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:I
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 AVE MUNOZ RIVERA
Mailing Address - Street 2:SUITE 1410 POPULAS CENTER PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-274-1741
Mailing Address - Fax:787-274-1776
Practice Address - Street 1:209 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 1410 POPULAS CENTER PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-274-1741
Practice Address - Fax:787-274-1776
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist