Provider Demographics
NPI:1962508689
Name:ORTEGA DENTAL OFFICE
Entity Type:Organization
Organization Name:ORTEGA DENTAL OFFICE
Other - Org Name:DENTAL ZACATECAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-263-3918
Mailing Address - Street 1:312 N SOTO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-263-3918
Mailing Address - Fax:323-263-4521
Practice Address - Street 1:312 N SOTO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-263-3918
Practice Address - Fax:323-263-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty