Provider Demographics
NPI:1174543458
Name:ORTEGA, MARCOS III (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:ORTEGA
Suffix:III
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 1:306 WALNUT AVE STE 25A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4980
Mailing Address - Country:US
Mailing Address - Phone:619-295-4545
Mailing Address - Fax:619-295-6575
Practice Address - Street 1:306 WALNUT AVE STE 25
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4980
Practice Address - Country:US
Practice Address - Phone:619-295-4545
Practice Address - Fax:619-295-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADY0346431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice