Provider Demographics
NPI:1548486301
Name:ORIEL, MARISSA BAUTISTA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:BAUTISTA
Last Name:ORIEL
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 1:11960 E. ARTESIA BLVD.
Mailing Address - Street 2:STE. 200
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4039
Mailing Address - Country:US
Mailing Address - Phone:562-468-1168
Mailing Address - Fax:562-468-1158
Practice Address - Street 1:11960 E. ARTESIA BLVD.
Practice Address - Street 2:STE. 200
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4039
Practice Address - Country:US
Practice Address - Phone:562-468-1168
Practice Address - Fax:562-468-1158
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice