Provider Demographics
NPI:1568513760
Name:ORSBORN, KHALIL J
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:J
Last Name:ORSBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9561
Mailing Address - Country:US
Mailing Address - Phone:803-699-8196
Mailing Address - Fax:
Practice Address - Street 1:2262 DUNN AVE STE 4
Practice Address - Street 2:SUITE #4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4720
Practice Address - Country:US
Practice Address - Phone:904-745-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics