Provider Demographics
NPI:1871786491
Name:ORTEGON, SERGIO (DDS, MDSCI)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:ORTEGON
Suffix:
Gender:M
Credentials:DDS, MDSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 BELLAIRE BLVD
Mailing Address - Street 2:STE 525
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-664-9900
Mailing Address - Fax:713-662-3300
Practice Address - Street 1:4747 BELLAIRE BLVD
Practice Address - Street 2:STE 525
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-664-9900
Practice Address - Fax:713-662-3300
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics