Organization
OTA DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORA C OTA DDS (OWNER)
(909) 797-8090
Entity
Organization
Contact information
Practice address
11834 BRYANT ST, #103, YUCAIPA, CA 92399-3815
(909) 797-8090
Mailing address
11834 BRYANT ST, #103, YUCAIPA, CA 92399-3815
(909) 797-8090
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
57849
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57849
—
CA
Enumeration date
02/05/2013
Last updated
02/05/2013
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