Provider Demographics
NPI:1649943986
Name:OREJUDOS, MARIE ANTOINETTE DYQUIANGCO (DMD)
Entity type:Individual
Prefix:
First Name:MARIE ANTOINETTE
Middle Name:DYQUIANGCO
Last Name:OREJUDOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1720 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2429
Practice Address - Country:US
Practice Address - Phone:714-758-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist