Provider Demographics
NPI:1013915677
Name:ORTIZ CLASS, JORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:ORTIZ CLASS
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 1:618 CALLE INFANTE
Mailing Address - Street 2:EXT EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3663
Mailing Address - Country:US
Mailing Address - Phone:787-257-8550
Mailing Address - Fax:787-762-0440
Practice Address - Street 1:618 CALLE INFANTE
Practice Address - Street 2:EXT EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3663
Practice Address - Country:US
Practice Address - Phone:787-257-8550
Practice Address - Fax:787-762-0440
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice