Provider Demographics
NPI:1275946469
Name:MANLIO F. OROZCO DDS INC.
Entity Type:Organization
Organization Name:MANLIO F. OROZCO DDS INC.
Other - Org Name:SB VALLEY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANLIO
Authorized Official - Middle Name:FABIO
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-384-7374
Mailing Address - Street 1:555 S MOUNT VERNON AVE STE G
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2700
Mailing Address - Country:US
Mailing Address - Phone:909-384-7374
Mailing Address - Fax:909-384-7394
Practice Address - Street 1:555 S MOUNT VERNON AVE STE G
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2700
Practice Address - Country:US
Practice Address - Phone:909-384-7374
Practice Address - Fax:909-384-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62325261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental