Mark M Ortinau, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12093 Issued in MO

Practice address

12 Hutchinson Rd
Ellisville, MO 63011-5702

Phone

(636) 391-0122

Fax

(636) 391-0185

NPI assigned

Jun 6, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1215976758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 HUTCHINSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630115702",
            "telephone_number": "636-391-0122",
            "fax_number": "636-391-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 HUTCHINSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630115702",
            "telephone_number": "636-391-0122",
            "fax_number": "636-391-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTINAU",
        "first_name": "MARK",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "12093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.