Provider Demographics
NPI:1326732249
Name:ORTIZ VALLE, LILIANA (DDS)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:ORTIZ VALLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 BANA VILLA CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1072
Mailing Address - Country:US
Mailing Address - Phone:813-850-5016
Mailing Address - Fax:
Practice Address - Street 1:2119 W BRANDON BLVD STE F
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4731
Practice Address - Country:US
Practice Address - Phone:813-850-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN309061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty