Provider Demographics
NPI:1235582735
Name:ORPHEE, JIMMY (DMD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:ORPHEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 TIMBERLINE RD W
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1161
Mailing Address - Country:US
Mailing Address - Phone:863-585-4997
Mailing Address - Fax:
Practice Address - Street 1:361 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3047
Practice Address - Country:US
Practice Address - Phone:863-439-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist