Healthcare Provider Details

I. General information

NPI: 1366478828
Provider Name (Legal Business Name): JEFFREY J ORCHEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 WARRENSVILLE CENTER ROAD
MAPLE HEIGHTS OH
44137-3125
US

IV. Provider business mailing address

5525 WARRENSVILLE CENTER ROAD
MAPLE HEIGHTS OH
44137-3125
US

V. Phone/Fax

Practice location:
  • Phone: 216-663-1967
  • Fax: 216-663-1819
Mailing address:
  • Phone: 216-663-1967
  • Fax: 216-663-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15639
License Number StateOH

VIII. Authorized Official

Name: MRS. KRISTY LYNN FAKADEJ
Title or Position: OFFICE MANAGER
Credential:
Phone: 216-663-1967