Provider Demographics
NPI:1780958660
Name:ORTIZ-JUNCEDA, MANUEL AMADO
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:AMADO
Last Name:ORTIZ-JUNCEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 AVE HOSTOS
Mailing Address - Street 2:EL MONTE SUR TH APT. G-512
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4258
Mailing Address - Country:US
Mailing Address - Phone:787-764-8448
Mailing Address - Fax:787-764-8448
Practice Address - Street 1:145 AVE HOSTOS
Practice Address - Street 2:EL MONTE SUR TH APT. G-512
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4258
Practice Address - Country:US
Practice Address - Phone:787-764-8448
Practice Address - Fax:787-764-8448
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics