MEDICARE: MRS. LILIA ANA ORTIZ R.D.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	11371	TX

General Provider Information

NPI Number	:	1528278942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILIA ANA ORTIZ R.D.H.

Provider Business Mailing Address
First Line	:	828 QUAIL TER
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1528
Country	:	US
Telephone Number	:	469-556-6729
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S DENTON TAP RD STE 270-A
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-3297
Country	:	US
Telephone Number	:	972-393-2663
Fax Number	:	972-304-6362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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