Healthcare Provider Details

I. General information

NPI: 1396137642
Provider Name (Legal Business Name): AMELIA L ORTA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 19TH ST NW STE 306
WASHINGTON DC
20036-2468
US

IV. Provider business mailing address

16729 MILLER LN
PARKTON MD
21120-9775
US

V. Phone/Fax

Practice location:
  • Phone: 202-293-7177
  • Fax:
Mailing address:
  • Phone: 404-804-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN1001905
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: