Provider Demographics
NPI:1720205834
Name:ORCUTT, BRIAN S (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:ORCUTT
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 1:7840 MADISON AVE
Mailing Address - Street 2:185
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3518
Mailing Address - Country:US
Mailing Address - Phone:916-961-8454
Mailing Address - Fax:916-961-8433
Practice Address - Street 1:7840 MADISON AVE
Practice Address - Street 2:185
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3518
Practice Address - Country:US
Practice Address - Phone:916-961-8454
Practice Address - Fax:916-961-8433
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice