Active NPI
Gustavo Avila Ortiz, D.D.S., M.S., PH.D
- Periodontics
- Ann Arbor, MI
National Provider Identifier
1730487224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2952000392
- Practice address
- 1011 N University Ave
Ann Arbor, MI 48109-1078 - Phone
- (734) 763-6933
- NPI assigned
- Mar 7, 2011
- Last updated
- Oct 22, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2952000392 | MI | Primary |
Addresses
Primary practice location
1011 N University Ave
Ann Arbor, MI 48109-1078
Mailing address
1011 N University Ave
Dent Room 3393
Ann Arbor, MI 48109-1078
Phone (734) 763-6933
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)
- Enrolled
- Credentials
- Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2952000392 | MI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1730487224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 N UNIVERSITY AVE",
"address_2": "DENT ROOM 3393",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481091078",
"telephone_number": "734-763-6933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 N UNIVERSITY AVE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481091078",
"telephone_number": "734-763-6933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVILA ORTIZ",
"first_name": "GUSTAVO",
"credential": "D.D.S., M.S., PH.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-07",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "2952000392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.