Provider Demographics
NPI:1306312301
Name:ORTIZ CAMACHO, LILIANA ALEJANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:ALEJANDRA
Last Name:ORTIZ CAMACHO
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 1:320 E 23RD ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4725
Mailing Address - Country:US
Mailing Address - Phone:347-557-6844
Mailing Address - Fax:
Practice Address - Street 1:320 E 23RD ST APT 2F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4725
Practice Address - Country:US
Practice Address - Phone:347-557-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00000097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist