Provider Demographics
NPI:1568476406
Name:ORTNER, PAUL PETER IV (DDS, CAGS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PETER
Last Name:ORTNER
Suffix:IV
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16679 BOONES FERRY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4368
Mailing Address - Country:US
Mailing Address - Phone:503-635-2100
Mailing Address - Fax:503-635-9188
Practice Address - Street 1:16679 BOONES FERRY RD STE 205
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4368
Practice Address - Country:US
Practice Address - Phone:503-635-2100
Practice Address - Fax:503-635-9188
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-71261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics