Provider Demographics
NPI:1255685962
Name:ORSAK, DANNY OSWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:OSWARD
Last Name:ORSAK
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 1:11049 FM 1960 RD W STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:281-469-4500
Mailing Address - Fax:281-469-2114
Practice Address - Street 1:11049 FM 1960 RD W, STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065
Practice Address - Country:US
Practice Address - Phone:281-469-4500
Practice Address - Fax:281-469-2114
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076937-02Medicaid