Provider Demographics
NPI:1770980930
Name:ORTIZ DENTAL INC
Entity type:Organization
Organization Name:ORTIZ DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ OLIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-757-5037
Mailing Address - Street 1:1910 MISSION AVE STE D
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7129
Mailing Address - Country:US
Mailing Address - Phone:760-757-5037
Mailing Address - Fax:760-757-5199
Practice Address - Street 1:1910 MISSION AVE STE D
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7129
Practice Address - Country:US
Practice Address - Phone:760-757-5037
Practice Address - Fax:760-757-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225435928OtherNPI