Provider Demographics
NPI:1891308433
Name:ORTEGA REGUEIRA, LUIS ORLANDO SR (DMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ORLANDO
Last Name:ORTEGA REGUEIRA
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 OLD ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7388
Mailing Address - Country:US
Mailing Address - Phone:281-520-2150
Mailing Address - Fax:
Practice Address - Street 1:803 E NASA PKWY STE 120
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5303
Practice Address - Country:US
Practice Address - Phone:281-286-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist