MEDICARE: DR. JORDAN ALEXANDER OROZCO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	39205	TX
2	122300000X	Dentist	104005	CA
3	122300000X	Dentist	7963	NV

General Provider Information

NPI Number	:	1114560927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN ALEXANDER OROZCO DDS

Provider Business Mailing Address
First Line	:	529 12TH ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-4825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 LEMMON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2706
Country	:	US
Telephone Number	:	214-522-4444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	07/09/2024

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