Provider Demographics
NPI:1396507034
Name:ORTIZ, OSCAR III (RDH)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:ORTIZ
Suffix:III
Gender:M
Credentials:RDH
Other - Prefix:MR
Other - First Name:OSCAR
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:OSCAR ORTIZ RDH
Mailing Address - Street 1:503 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2226
Mailing Address - Country:US
Mailing Address - Phone:562-332-8542
Mailing Address - Fax:
Practice Address - Street 1:1419 E 60TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1216
Practice Address - Country:US
Practice Address - Phone:562-332-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
CA35537124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist