Provider Demographics
NPI:1962134940
Name:ORTIZ CEDENO, JUAN CARLOS (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN CARLOS
Middle Name:
Last Name:ORTIZ CEDENO
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 1:3970 SW 24TH AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4489
Mailing Address - Country:US
Mailing Address - Phone:585-448-5603
Mailing Address - Fax:
Practice Address - Street 1:3970 SW 24TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4485
Practice Address - Country:US
Practice Address - Phone:585-448-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0632423771340OtherDRIVER LICENSE