Provider Demographics
NPI:1821212614
Name:ORZAME, HARLEY S (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:S
Last Name:ORZAME
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 1:1365 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1600
Mailing Address - Country:US
Mailing Address - Phone:626-917-1267
Mailing Address - Fax:626-918-9647
Practice Address - Street 1:1365 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1600
Practice Address - Country:US
Practice Address - Phone:626-917-1267
Practice Address - Fax:626-918-9647
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA506002OtherDENTICAL