Provider Demographics
NPI:1477375160
Name:MARIE ANTOINETTE OREJUDOS DMD INC.
Entity type:Organization
Organization Name:MARIE ANTOINETTE OREJUDOS DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE ANTOINETTE
Authorized Official - Middle Name:DYQUIANGCO
Authorized Official - Last Name:OREJUDOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-795-9804
Mailing Address - Street 1:610 S FANN PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2623
Mailing Address - Country:US
Mailing Address - Phone:714-795-9804
Mailing Address - Fax:
Practice Address - Street 1:215 N STATE COLLEGE BLVD STE J
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2995
Practice Address - Country:US
Practice Address - Phone:714-795-9804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental