Provider Demographics
NPI:1467452151
Name:JACKSONVILLE UNIVERSITY SCHOOL OF ORTHODONTICS
Entity Type:Organization
Organization Name:JACKSONVILLE UNIVERSITY SCHOOL OF ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-256-7847
Mailing Address - Street 1:2800 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3321
Mailing Address - Country:US
Mailing Address - Phone:904-256-7847
Mailing Address - Fax:904-256-7889
Practice Address - Street 1:2800 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3321
Practice Address - Country:US
Practice Address - Phone:904-256-7847
Practice Address - Fax:904-256-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP4491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty