Provider Demographics
NPI:1396137642
Name:ORTA, AMELIA L (DMD)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:L
Last Name:ORTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16729 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9775
Mailing Address - Country:US
Mailing Address - Phone:404-804-6129
Mailing Address - Fax:
Practice Address - Street 1:1234 19TH ST NW STE 306
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2468
Practice Address - Country:US
Practice Address - Phone:202-293-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
DCDEN10019051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program