Provider Demographics
NPI:1720702129
Name:MARK ORTEGA D.D.S., INC
Entity Type:Organization
Organization Name:MARK ORTEGA D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-804-5931
Mailing Address - Street 1:5175 E PACIFIC COAST HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3315
Mailing Address - Country:US
Mailing Address - Phone:562-597-2448
Mailing Address - Fax:562-597-0639
Practice Address - Street 1:5175 E PACIFIC COAST HWY STE 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3315
Practice Address - Country:US
Practice Address - Phone:323-804-5391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty