Provider Demographics
NPI:1255079513
Name:ORCHID ENTERPRISES
Entity type:Organization
Organization Name:ORCHID ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SYRJAMAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-562-3736
Mailing Address - Street 1:2121 S WEBSTER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2290
Mailing Address - Country:US
Mailing Address - Phone:920-437-8017
Mailing Address - Fax:920-437-4852
Practice Address - Street 1:2121 S WEBSTER AVE STE 3
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2290
Practice Address - Country:US
Practice Address - Phone:920-437-8017
Practice Address - Fax:920-437-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental