MEDICARE: DR. GUILLERMO ENRIQUE ORRACA II D.M.D.

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	1223P0700X	Prosthodontics	00962	PR

General Provider Information

NPI Number	:	1144219411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUILLERMO ENRIQUE ORRACA II D.M.D.

Provider Business Mailing Address
First Line	:	502 JULIAN AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-4914
Country	:	US
Telephone Number	:	301-751-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	15TH AEROMEDICAL-DENTAL SQUADRON
Second Line	:	755 SCOTT CIRCLE
City	:	HICKAM AFB
State	:	HI
Zip	:	96853-5399
Country	:	US
Telephone Number	:	301-751-0676
Fax Number	:

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	11/13/2007

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