Provider Demographics
NPI:1245415108
Name:ORSI, JOHN DOMINIC (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOMINIC
Last Name:ORSI
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 1:2605 EASTERN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6614
Mailing Address - Country:US
Mailing Address - Phone:916-482-7117
Mailing Address - Fax:916-482-6721
Practice Address - Street 1:2605 EASTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6614
Practice Address - Country:US
Practice Address - Phone:916-482-7117
Practice Address - Fax:916-482-6721
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice