Provider Demographics
NPI:1598100810
Name:OROZCO, MANLIO FABIO (DDS)
Entity Type:Individual
Prefix:
First Name:MANLIO
Middle Name:FABIO
Last Name:OROZCO
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 1:555 S MOUNT VERNON AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2749
Mailing Address - Country:US
Mailing Address - Phone:909-384-7374
Mailing Address - Fax:
Practice Address - Street 1:555 S MOUNT VERNON AVE
Practice Address - Street 2:SUITE G
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2749
Practice Address - Country:US
Practice Address - Phone:909-384-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist