Individual
DR. MARK GREGORY ORTIZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
432 W MAIN ST, CLARKSBURG, WV 26301-2817
(304) 622-9837
(304) 623-1754
Mailing address
432 W MAIN ST, CLARKSBURG, WV 26301-2817
(304) 622-9837
(304) 623-1754
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV3025
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0132990000
—
WV
01
—
486411
UNITED CONCORDIA PROVIDER
WV
Enumeration date
06/15/2006
Last updated
07/09/2007
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