Provider Demographics
NPI:1871654939
Name:ORRICK, JAIME L (DDS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:ORRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RILEY HOSPITAL DR RM 4205
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-944-3865
Mailing Address - Fax:317-944-9653
Practice Address - Street 1:705 RILEY HOSPITAL DR RM 4205
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-3865
Practice Address - Fax:317-944-9653
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060293151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1653349OtherTAX ID #