Provider Demographics
NPI:1164750352
Name:OROZCO, JACOB RICHARD (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:RICHARD
Last Name:OROZCO
Suffix:
Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:2021 GREEN ST
Mailing Address - Street 2:APT 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3457
Mailing Address - Country:US
Mailing Address - Phone:267-303-9494
Mailing Address - Fax:
Practice Address - Street 1:6404 ROOSEVELT BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2943
Practice Address - Country:US
Practice Address - Phone:215-743-4700
Practice Address - Fax:215-743-3706
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-26
Last Update Date:2013-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS0372071223X0400X
NJDI024308001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics