Provider Demographics
NPI:1871648311
Name:ORTEGA, ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
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 1:13450 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5806
Mailing Address - Country:US
Mailing Address - Phone:310-679-0106
Mailing Address - Fax:310-679-6698
Practice Address - Street 1:13450 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5806
Practice Address - Country:US
Practice Address - Phone:310-679-0106
Practice Address - Fax:310-679-6698
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice