Provider Demographics
NPI:1194883835
Name:ORTIZ-PEREZ, MARTA (DMD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:ORTIZ-PEREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13846 SW 56 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175
Mailing Address - Country:US
Mailing Address - Phone:305-380-8050
Mailing Address - Fax:305-385-9122
Practice Address - Street 1:PEDIATRIC DENTAL ASSOCIATES
Practice Address - Street 2:13846 SW 56 STREET
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:305-380-8050
Practice Address - Fax:305-385-9122
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071513101Medicaid