Provider Demographics
NPI:1902398639
Name:TALLAHASSEE ORAL AND MAXILLOFACIAL SURGERY, PLLC
Entity Type:Organization
Organization Name:TALLAHASSEE ORAL AND MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:787-556-6039
Mailing Address - Street 1:3665 COOLIDGE CT STE 102
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7894
Mailing Address - Country:US
Mailing Address - Phone:850-431-6725
Mailing Address - Fax:850-431-6859
Practice Address - Street 1:3665 COOLIDGE CT STE 102
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7894
Practice Address - Country:US
Practice Address - Phone:850-431-6725
Practice Address - Fax:850-431-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty