Provider Demographics
NPI:1629637517
Name:ORTIZ, JULIAN
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N FEDERAL HWY STE 13
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1416
Mailing Address - Country:US
Mailing Address - Phone:954-563-4274
Mailing Address - Fax:954-563-9312
Practice Address - Street 1:3000 N FEDERAL HWY STE 13
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1416
Practice Address - Country:US
Practice Address - Phone:954-563-4274
Practice Address - Fax:954-563-9312
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist