Provider Demographics
NPI:1366538571
Name:ORTIZ & MOSS DENTAL ASSOCIATES, P.C
Entity type:Organization
Organization Name:ORTIZ & MOSS DENTAL ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEREIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-662-2426
Mailing Address - Street 1:2101 TRINITY DR STE P
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4103
Mailing Address - Country:US
Mailing Address - Phone:505-662-2426
Mailing Address - Fax:
Practice Address - Street 1:2101 TRINITY DR STE P
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4103
Practice Address - Country:US
Practice Address - Phone:505-662-2426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM17001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty