Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901020161 | MI |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2901020161 | MI |
NPI | 1013110824 |
---|---|
Provider Name | Dr. Leslie Ann Orzech |
First Address | Grand Blanc, MI 48439-7637 |
Second Address | Warren, MI 48092-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 22/07/2021 |