Provider Demographics
NPI:1851091185
Name:JOSEPH ORTEGA, ELIZABETH (DMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JOSEPH ORTEGA
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 1:11415 SW DISCOVERY WAY APT 107
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2578
Mailing Address - Country:US
Mailing Address - Phone:689-250-7795
Mailing Address - Fax:
Practice Address - Street 1:2015 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1901
Practice Address - Country:US
Practice Address - Phone:863-763-1951
Practice Address - Fax:844-540-4798
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN285831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice