Provider Demographics
NPI:1225731441
Name:ORTEGON, GUSTAVO ADOLFO (DDS)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:ORTEGON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 HAMILTON WOLFE RD APT 3214
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0019
Mailing Address - Country:US
Mailing Address - Phone:954-778-6376
Mailing Address - Fax:
Practice Address - Street 1:111 N ASH ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-3201
Practice Address - Country:US
Practice Address - Phone:830-334-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist