Provider Demographics
NPI:1437383684
Name:ORLICH, CHAD LEON (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:LEON
Last Name:ORLICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 BULLARD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-4403
Mailing Address - Country:US
Mailing Address - Phone:512-740-0867
Mailing Address - Fax:
Practice Address - Street 1:5805 BULLARD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-4403
Practice Address - Country:US
Practice Address - Phone:512-740-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17995122300000X
TX259501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist