Provider Demographics
NPI:1053823278
Name:ORTEZA, RODOLFO LOPEZ JR (DDS)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:LOPEZ
Last Name:ORTEZA
Suffix:JR
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 1:120 FREMONT HUB COURTYARD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-7701
Mailing Address - Country:US
Mailing Address - Phone:510-744-1300
Mailing Address - Fax:510-744-1303
Practice Address - Street 1:120 FREMONT HUB COURTYARD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-7701
Practice Address - Country:US
Practice Address - Phone:510-744-1300
Practice Address - Fax:510-744-1303
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1020491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice