Provider Demographics
NPI:1689164782
Name:MALDONADO-ORTIZ, JOSE ORLANDO (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ORLANDO
Last Name:MALDONADO-ORTIZ
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 EMBER WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-9247
Mailing Address - Country:US
Mailing Address - Phone:787-557-6769
Mailing Address - Fax:
Practice Address - Street 1:450 SYNDICATE ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4107
Practice Address - Country:US
Practice Address - Phone:651-254-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND139881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice