Provider Demographics
NPI:1679603427
Name:ORTIZ, VIRGILIO (DMD)
Entity type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BP19 CALLE 115
Mailing Address - Street 2:JARDINES DE COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2110
Mailing Address - Country:US
Mailing Address - Phone:787-750-7179
Mailing Address - Fax:
Practice Address - Street 1:AVE. ROBERTO CLEMENTE 50 BLK.111
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-0680
Practice Address - Fax:787-757-0680
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist