1093710980 NPI number — DR. JUDITH ORTIZ COLON DMD

Table of content: DR. JUDITH ORTIZ COLON DMD (NPI 1093710980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093710980 NPI number — DR. JUDITH ORTIZ COLON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ COLON
Provider First Name:
JUDITH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093710980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE ALELI #66 URB FULLANA
Provider Second Line Business Mailing Address:
EDIF MICHAELANGELO
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-263-8940
Provider Business Mailing Address Fax Number:
787-263-7882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ALELI #66 URB FULLANA
Provider Second Line Business Practice Location Address:
EDIF MICHAELANGELO PROFESSIONAL CENTRE
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-263-8940
Provider Business Practice Location Address Fax Number:
787-263-7882
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2287 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42361 . This is a "SSS DENTAL PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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