Provider Demographics
NPI:1366478828
Name:JEFFREY J ORCHEN DDS INC
Entity Type:Organization
Organization Name:JEFFREY J ORCHEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FAKADEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-663-1967
Mailing Address - Street 1:5525 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3125
Mailing Address - Country:US
Mailing Address - Phone:216-663-1967
Mailing Address - Fax:216-663-1819
Practice Address - Street 1:5525 WARRENSVILLE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3125
Practice Address - Country:US
Practice Address - Phone:216-663-1967
Practice Address - Fax:216-663-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0363646Medicaid
112774OtherCIGNA HMO
476811OtherUNITED CONCORDIA
000472OtherDORAL
603924OtherCOMPBENEFITS
MIJ679523OtherBCBS MICHIGAN
000000165484OtherANTHEM BCBS
MIJ679523OtherBCBS MICHIGAN
112774OtherCIGNA HMO