Provider Demographics
NPI:1356499941
Name:ORAZEM, EDMUND GARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:GARRETT
Last Name:ORAZEM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GARRETT
Other - Middle Name:
Other - Last Name:ORAZEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 4784
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0941
Mailing Address - Country:US
Mailing Address - Phone:508-693-1951
Mailing Address - Fax:508-693-1994
Practice Address - Street 1:31 BEACH ROAD
Practice Address - Street 2:UNIT A202
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-1951
Practice Address - Fax:508-693-1994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice