Provider Demographics
NPI:1487003125
Name:ORZABAL, MATTHEW CHRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:ORZABAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 W SACK DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7611
Mailing Address - Country:US
Mailing Address - Phone:623-512-2005
Mailing Address - Fax:
Practice Address - Street 1:5270 W BASELINE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6959
Practice Address - Country:US
Practice Address - Phone:602-237-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ94501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice