Provider Demographics
NPI:1194813808
Name:ORJANSEN, MARC DANA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DANA
Last Name:ORJANSEN
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1511 NORTHWAY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1261
Mailing Address - Country:US
Mailing Address - Phone:320-240-9028
Mailing Address - Fax:320-240-9048
Practice Address - Street 1:1511 NORTHWAY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1261
Practice Address - Country:US
Practice Address - Phone:320-240-9028
Practice Address - Fax:320-240-9048
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND112961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics