Provider Demographics
NPI:1225109341
Name:ORCHEN, JEFFREY JULES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JULES
Last Name:ORCHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1444
Mailing Address - Country:US
Mailing Address - Phone:216-663-1967
Mailing Address - Fax:
Practice Address - Street 1:5525 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3125
Practice Address - Country:US
Practice Address - Phone:216-663-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0363646Medicaid
OH112774OtherCIGNA
OH341373074028OtherDORAL
OHJ679523OtherBC BS MI
OH000000165484OtherANTHEM
OH476811OtherUNITED CONCORDIA
OH000472OtherCARESOURCE