Provider Demographics
NPI:1083999114
Name:ORRIN D. MITCHELL, D.D.S., P.A.
Entity Type:Organization
Organization Name:ORRIN D. MITCHELL, D.D.S., P.A.
Other - Org Name:JACKSONVILLE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ORRIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-766-6000
Mailing Address - Street 1:1190 EDGEWOOD AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3419
Mailing Address - Country:US
Mailing Address - Phone:904-766-6000
Mailing Address - Fax:904-766-6003
Practice Address - Street 1:1190 EDGEWOOD AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3419
Practice Address - Country:US
Practice Address - Phone:904-766-6000
Practice Address - Fax:904-766-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 6224261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
6726890001Medicare NSC