Provider Demographics
NPI:1700519964
Name:ORTEGA, BEATRIZ GABRIELA (DDS)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:GABRIELA
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 1:29415 KICKAPOO MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-9582
Mailing Address - Country:US
Mailing Address - Phone:346-349-7113
Mailing Address - Fax:
Practice Address - Street 1:3301 CLOVIS RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-5155
Practice Address - Country:US
Practice Address - Phone:806-791-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist