1861601593 NPI number — NHORA ORTEGA D.D.S CORP

Table of content: (NPI 1861601593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861601593 NPI number — NHORA ORTEGA D.D.S CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NHORA ORTEGA D.D.S CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1861601593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13851 SW 38TH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33175-6490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-804-2624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 NW 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-446-8115
Provider Business Practice Location Address Fax Number:
305-446-5023
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
NHORA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-804-2624

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN 16037 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DN 16037 . This is a "DENTAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".