Provider Demographics
NPI:1851585327
Name:ORTIZ RODRIGUEZ, RAUL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:A
Last Name:ORTIZ RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S OSPREY AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2918
Mailing Address - Country:US
Mailing Address - Phone:941-366-0474
Mailing Address - Fax:941-366-0292
Practice Address - Street 1:1515 S OSPREY AVE STE A2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2918
Practice Address - Country:US
Practice Address - Phone:941-366-0474
Practice Address - Fax:941-366-0292
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist