Provider Demographics
NPI:1538394879
Name:ORTIZ ALBA, LORENA D (DDS)
Entity type:Individual
Prefix:MS
First Name:LORENA
Middle Name:D
Last Name:ORTIZ ALBA
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 1:1437 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PADRE DE LAS CASA #301 ESQ. CON MATAMOROS
Practice Address - Street 2:
Practice Address - City:PIEDRAS NEGRAS
Practice Address - State:COAHUILA
Practice Address - Zip Code:26000
Practice Address - Country:MX
Practice Address - Phone:830-325-9427
Practice Address - Fax:01152878-782-4577
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2783524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist