Provider Demographics
NPI:1437319852
Name:ORELLANA, GRISELDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRISELDA
Middle Name:
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GRISELDA
Other - Middle Name:
Other - Last Name:ORELLANA ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6654 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3533
Mailing Address - Country:US
Mailing Address - Phone:562-222-2833
Mailing Address - Fax:562-222-2853
Practice Address - Street 1:6654 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3533
Practice Address - Country:US
Practice Address - Phone:562-222-2833
Practice Address - Fax:562-222-2853
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice