Provider Demographics
NPI:1881901981
Name:ORTEGA, LISSETTE CARLA (DDS)
Entity type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:CARLA
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 1:9312 MOSS CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:972-742-7536
Mailing Address - Fax:
Practice Address - Street 1:301 E CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4635
Practice Address - Country:US
Practice Address - Phone:214-396-9494
Practice Address - Fax:214-396-9495
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice