Provider Demographics
NPI:1760504922
Name:ORTEGA, DAVID JOAQUIN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOAQUIN
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7604
Mailing Address - Country:US
Mailing Address - Phone:505-984-0881
Mailing Address - Fax:505-984-3051
Practice Address - Street 1:550 SAINT MICHAELS DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7604
Practice Address - Country:US
Practice Address - Phone:505-984-0881
Practice Address - Fax:505-984-3051
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist