Provider Demographics
NPI:1023080041
Name:ORTIZ-QUILES, LUIS E (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:ORTIZ-QUILES
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 1:1218 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1535
Mailing Address - Country:US
Mailing Address - Phone:210-928-2814
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST ST
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4810
Practice Address - Country:US
Practice Address - Phone:512-458-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21691223G0001X
TX22560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice