Provider Demographics
NPI:1184705717
Name:THE ORTHODONTIC OFFICE OF DR. ANN MARIE GORCZYCA
Entity type:Organization
Organization Name:THE ORTHODONTIC OFFICE OF DR. ANN MARIE GORCZYCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GORCZYCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH, MS
Authorized Official - Phone:925-757-9000
Mailing Address - Street 1:5201 DEER VALLEY RD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7429
Mailing Address - Country:US
Mailing Address - Phone:925-757-9000
Mailing Address - Fax:925-757-9651
Practice Address - Street 1:5201 DEER VALLEY RD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7429
Practice Address - Country:US
Practice Address - Phone:925-757-9000
Practice Address - Fax:925-757-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty