Provider Demographics
NPI:1528136876
Name:ORTIZ-LUIS, JOHN H (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:ORTIZ-LUIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25528 THE OLD RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1705
Mailing Address - Country:US
Mailing Address - Phone:661-255-9646
Mailing Address - Fax:661-255-9657
Practice Address - Street 1:25528 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1705
Practice Address - Country:US
Practice Address - Phone:661-255-9646
Practice Address - Fax:661-255-9657
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist