Provider Demographics
NPI:1922147826
Name:ORTIZ, CARLOS RODOLFO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RODOLFO
Last Name:ORTIZ
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 1:16215 STATE ROAD 50 STE 102
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6019
Mailing Address - Country:US
Mailing Address - Phone:407-654-4024
Mailing Address - Fax:407-654-4027
Practice Address - Street 1:16215 STATE ROAD 50 STE 102
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6019
Practice Address - Country:US
Practice Address - Phone:407-654-4024
Practice Address - Fax:407-654-4027
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 164101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice