Provider Demographics
NPI:1841324449
Name:ORTIZ, JESUS VICENTE (DDS)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:VICENTE
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 NORTH ALMA SCHOOL RD
Mailing Address - Street 2:#12
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-963-1856
Mailing Address - Fax:480-821-6695
Practice Address - Street 1:793 NORTH ALMA SCHOOL RD
Practice Address - Street 2:#12
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-963-1856
Practice Address - Fax:480-821-6695
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist