Provider Demographics
NPI:1306020219
Name:ORCHARD, JOHN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:ORCHARD
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 1:210 S PALISADE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8901
Mailing Address - Country:US
Mailing Address - Phone:805-925-9501
Mailing Address - Fax:805-925-2111
Practice Address - Street 1:210 S PALISADE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8901
Practice Address - Country:US
Practice Address - Phone:805-925-9501
Practice Address - Fax:805-925-2111
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD21396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist