NPIMap

Individual provider Active NPI

Jan N Ortiz, DMD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Richardson, TX
National Provider Identifier
1083808661
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
26164 Issued in TX
Practice address
700 E Campbell Rd Ste 230
Richardson, TX 75081-2042
Phone
(972) 479-1200
Fax
(972) 479-1203
NPI assigned
Aug 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 26164 TX Primary

Addresses

Primary practice location

700 E Campbell Rd Ste 230
Richardson, TX 75081-2042

Mailing address

700 E Campbell Rd Ste 230
Richardson, TX 75081-2042
Phone (972) 479-1200

Other identifiers 1

IdentifierTypeStateIssuer
287540301MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address janortiz@endoandperio.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
26164TXMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Super Smiles Dental Dentist Past Accepting new patients
Endodontic and Periodontic Specialists PastSince Oct 23, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1083808661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E CAMPBELL RD STE 230",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750812042",
            "telephone_number": "972-479-1200",
            "fax_number": "972-479-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E CAMPBELL RD STE 230",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750812042",
            "telephone_number": "972-479-1200",
            "fax_number": "972-479-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ",
        "first_name": "JAN",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "26164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287540301",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "janortiz@endoandperio.com",
            "affiliation": "N",
            "address_1": "700 E Campbell Rd Ste 230",
            "city": "Richardson",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750812042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.