Provider Demographics
NPI:1184207912
Name:ORANGE DMSO, LLC
Entity Type:Organization
Organization Name:ORANGE DMSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEVERN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIZZARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-937-4356
Mailing Address - Street 1:2165 W ORANGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3118
Mailing Address - Country:US
Mailing Address - Phone:520-800-0333
Mailing Address - Fax:
Practice Address - Street 1:2165 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3118
Practice Address - Country:US
Practice Address - Phone:520-800-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental