Individual
MIREYA E IMITOLA ORTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2305 CEDAR SPRINGS RD, DALLAS, TX 75201-1854
(214) 969-1000
Mailing address
2820 GOLDEN MEADOW AVE, MESQUITE, TX 75181-2147
(972) 310-1172
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
34534
TX
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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