Provider Demographics
NPI:1053652412
Name:MITCHELL R LEVINE DMD, PA, NORTH FLORIDA ORTHODONTICS
Entity Type:Organization
Organization Name:MITCHELL R LEVINE DMD, PA, NORTH FLORIDA ORTHODONTICS
Other - Org Name:JOY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:TUNSTILL
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:904-737-4626
Mailing Address - Street 1:3600 CARDINAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5581
Mailing Address - Country:US
Mailing Address - Phone:904-737-4626
Mailing Address - Fax:904-737-2126
Practice Address - Street 1:3600 CARDINAL POINT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5581
Practice Address - Country:US
Practice Address - Phone:904-737-4626
Practice Address - Fax:904-737-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty