Provider Demographics
NPI:1669760336
Name:L. STEPHEN ORTEGO D.D.S.
Entity type:Organization
Organization Name:L. STEPHEN ORTEGO D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ORTEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-640-1470
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-0766
Mailing Address - Country:US
Mailing Address - Phone:318-640-1470
Mailing Address - Fax:318-640-4700
Practice Address - Street 1:5813 MONROE HWY
Practice Address - Street 2:
Practice Address - City:BALL
Practice Address - State:LA
Practice Address - Zip Code:71405-3362
Practice Address - Country:US
Practice Address - Phone:318-640-1470
Practice Address - Fax:318-640-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty