Individual
JENNIFER M ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
107 W 4TH ST, MOUNT VERNON, NY 10550-4002
(914) 699-7200
(914) 699-0837
Mailing address
107 W 4TH ST, MOUNT VERNON, NY 10550-4002
(914) 699-7200
(914) 699-0837
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
055827
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02995513
—
NY
05
—
03406879
—
NY
Enumeration date
09/21/2011
Last updated
07/21/2022
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