Provider Demographics
NPI:1245359991
Name:ORTIZ-COLON, WALTER E (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:ORTIZ-COLON
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 1:3727 SW 8TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3158
Mailing Address - Country:US
Mailing Address - Phone:305-444-6203
Mailing Address - Fax:
Practice Address - Street 1:3727 SW 8TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3158
Practice Address - Country:US
Practice Address - Phone:305-444-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice