Provider Demographics
NPI:1750531091
Name:ORTIZ FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:ORTIZ FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:MOISES
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-659-6617
Mailing Address - Street 1:2141 HAMMERAND CT STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8250
Mailing Address - Country:US
Mailing Address - Phone:575-521-8720
Mailing Address - Fax:
Practice Address - Street 1:2141 HAMMERAND CT STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8250
Practice Address - Country:US
Practice Address - Phone:575-521-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD29031223G0001X
NMDD29081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty