Provider Demographics
NPI:1790002038
Name:ORTEGA, FABIOLA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:D
Last Name:ORTEGA
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 1:7032 SW 154TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2113
Mailing Address - Country:US
Mailing Address - Phone:305-586-2328
Mailing Address - Fax:
Practice Address - Street 1:8805 SW 144TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7218
Practice Address - Country:US
Practice Address - Phone:305-253-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147171223G0001X
FLDN195701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice