Ortiz, Mark Gregory

Ortiz, Mark Gregory is an individual health care provider with primary practice located at 432 W Main St , Clarksburg WV 26301-2817. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Ortiz, Mark Gregory can be contacted via phone (304) 622-9837.

Contact Information

Primary practice address
432 W Main St Clarksburg WV 26301-2817
Phone: (304) 622-9837
Fax: (304) 623-1754
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X WV3025 West Virginia

Profile Details

NPI number 1174567671
LBN Legal business name Ortiz, Mark Gregory
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174567671 NPPES
West Virginia Other 486411 UNITED CONCORDIA PROVIDER
West Virginia MEDICAID 0132990000 UNITED CONCORDIA PROVIDER

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