Provider Demographics
NPI:1487990297
Name:ORTIZ-SASTRE, DANA M (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:ORTIZ-SASTRE
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:ROYAL PALM IG-15
Mailing Address - Street 2:CRISANTEMO ST.
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-757-1800
Mailing Address - Fax:
Practice Address - Street 1:IG15 CALLE CRISANTEMO
Practice Address - Street 2:URB. ROYAL PALM
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3111
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice