Provider Demographics
NPI:1881836963
Name:ORTA, INES ALEJANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:INES
Middle Name:ALEJANDRA
Last Name:ORTA
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 1:1723 SW 2ND AVE UNIT 802.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129
Mailing Address - Country:US
Mailing Address - Phone:305-788-2613
Mailing Address - Fax:
Practice Address - Street 1:6600 WEST 12TH AVENUE.
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-788-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55321122300000X
FL203451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist