Provider Demographics
NPI:1205106002
Name:LORA OTA DDS, INC
Entity type:Organization
Organization Name:LORA OTA DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-543-3888
Mailing Address - Street 1:5708 PIRRONE RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9313
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty