Provider Demographics
NPI:1609408574
Name:ORTHO 99 PLUS 1
Entity Type:Organization
Organization Name:ORTHO 99 PLUS 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-559-0555
Mailing Address - Street 1:7410 MERRILL ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277
Mailing Address - Country:US
Mailing Address - Phone:904-619-7140
Mailing Address - Fax:
Practice Address - Street 1:7410 MERRILL ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277
Practice Address - Country:US
Practice Address - Phone:904-619-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty