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General NPI Number Information
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NPI Number | 1881901981
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Entity Type | Individual
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Provider Name | LISSETTE CARLA ORTEGA DDS
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Gender | Female
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 301 E CENTERVILLE RD
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City | GARLAND
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State | TX
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Zip | 75041-4635
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Country | US
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Telephone | 214-396-9494
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Fax | 214-396-9495
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Provider Business Mailing Address
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Address Line | 9312 MOSS CIRCLE DR
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City | DALLAS
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State | TX
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Zip | 75243
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Country | US
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Telephone | 972-742-7536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25723
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License Number State | TX
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