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General NPI Number Information
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NPI Number | 1366889321
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Entity Type | Individual
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Provider Name | JOSEPH RICHARD ORNELAS D.D.S
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Gender | Male
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 1123 JOLIET ST
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City | DYER
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State | IN
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Zip | 46311-1926
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Country | US
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Telephone | 219-865-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 5030 W 125TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-8751
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Country | US
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Telephone | 219-545-4072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011967A
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License Number State | IN
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