Provider Demographics
NPI:1831127950
Name:ORTIZ, ENID (DMD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0001
Mailing Address - Country:US
Mailing Address - Phone:787-733-2363
Mailing Address - Fax:787-733-1166
Practice Address - Street 1:CARR. 183 KM. 16.8
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-2363
Practice Address - Fax:787-733-1166
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14341223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice