Provider Demographics
NPI:1700921574
Name:ORTMAN, WILLIAM RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:ORTMAN
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 1:2655 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3304
Mailing Address - Country:US
Mailing Address - Phone:203-281-0239
Mailing Address - Fax:203-230-9248
Practice Address - Street 1:2655 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3304
Practice Address - Country:US
Practice Address - Phone:203-281-0239
Practice Address - Fax:203-230-9248
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist