Provider Demographics
NPI:1134452972
Name:ORNISH, IRWIN KENNETH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:KENNETH
Last Name:ORNISH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11661 PRESTON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2715
Mailing Address - Country:US
Mailing Address - Phone:214-373-9400
Mailing Address - Fax:214-373-9419
Practice Address - Street 1:11661 PRESTON RD STE 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2715
Practice Address - Country:US
Practice Address - Phone:214-373-9400
Practice Address - Fax:214-373-9419
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics