Provider Demographics
NPI:1336240340
Name:ORTALE, KEVIN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:ORTALE
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 1:702 EAST BELL ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6639
Mailing Address - Country:US
Mailing Address - Phone:602-404-0330
Mailing Address - Fax:602-404-0312
Practice Address - Street 1:702 E BELL RD
Practice Address - Street 2:SUITE 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6639
Practice Address - Country:US
Practice Address - Phone:602-404-0330
Practice Address - Fax:602-404-0312
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist