Provider Demographics
NPI:1992959332
Name:OTA, LORA C (DDS)
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:C
Last Name:OTA
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 1:5708 PIRRONE RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368
Mailing Address - Country:US
Mailing Address - Phone:209-543-3888
Mailing Address - Fax:209-543-3833
Practice Address - Street 1:5708 PIRRONE RD
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9313
Practice Address - Country:US
Practice Address - Phone:209-543-3888
Practice Address - Fax:209-543-3833
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice