Provider Demographics
NPI:1881961076
Name:ENDODONTIC AND PERIODONTIC SPECIALISTS
Entity type:Organization
Organization Name:ENDODONTIC AND PERIODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-367-2580
Mailing Address - Street 1:700 E CAMPBELL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2041
Mailing Address - Country:US
Mailing Address - Phone:972-479-1200
Mailing Address - Fax:972-479-1203
Practice Address - Street 1:700 E CAMPBELL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2041
Practice Address - Country:US
Practice Address - Phone:972-479-1200
Practice Address - Fax:972-479-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258741223E0200X
TX261681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty