Provider Demographics
NPI:1528278942
Name:ORTIZ, LILIA ANA (RDH)
Entity type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:ANA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LILIA
Other - Middle Name:ANA
Other - Last Name:ORTIZ-GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:828 QUAIL TER
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1528
Mailing Address - Country:US
Mailing Address - Phone:469-556-6729
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD STE 270-A
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3297
Practice Address - Country:US
Practice Address - Phone:972-393-2663
Practice Address - Fax:972-304-6362
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11371124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist