Provider Demographics
NPI:1811742786
Name:RADA ORBEGOZO, SANDRA LILIANA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LILIANA
Last Name:RADA ORBEGOZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 FEDERAL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-1508
Mailing Address - Country:US
Mailing Address - Phone:470-209-9848
Mailing Address - Fax:
Practice Address - Street 1:1636 FEDERAL CREEK LN
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-1508
Practice Address - Country:US
Practice Address - Phone:470-209-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.004729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist