Provider Demographics
NPI:1659811883
Name:JOHN H. ORTIZ-LUIS, DMD, INC.
Entity Type:Organization
Organization Name:JOHN H. ORTIZ-LUIS, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ORTIZ-LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-255-9646
Mailing Address - Street 1:25528 THE OLD RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1705
Mailing Address - Country:US
Mailing Address - Phone:661-255-9646
Mailing Address - Fax:661-255-9657
Practice Address - Street 1:25528 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1705
Practice Address - Country:US
Practice Address - Phone:661-255-9646
Practice Address - Fax:661-255-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty