Individual provider Active NPI

Marcos Ortega III, D.D.S.

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1174543458
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DY034643 Issued in CA
Practice address
306 Walnut Ave Ste 25
San Diego, CA 92103-4980
Phone
(619) 295-4545
Fax
(619) 295-6575
NPI assigned
Jul 20, 2006
Last updated
Aug 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DY034643 CA Primary

Addresses

Primary practice location

306 Walnut Ave Ste 25
San Diego, CA 92103-4980

Mailing address

306 Walnut Ave Ste 25a
San Diego, CA 92103-4980
Phone (619) 295-4545

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
DY034643CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Marcos Ortega DDS Inc Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1174543458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 WALNUT AVE STE 25A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034980",
            "telephone_number": "619-295-4545",
            "fax_number": "619-295-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 WALNUT AVE STE 25",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034980",
            "telephone_number": "619-295-4545",
            "fax_number": "619-295-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTEGA",
        "first_name": "MARCOS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DY034643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.