Provider Demographics
NPI:1972500908
Name:ORTHODONTIC OPTIONS, LLC
Entity Type:Organization
Organization Name:ORTHODONTIC OPTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-398-6461
Mailing Address - Street 1:3457 HENDRICKS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5307
Mailing Address - Country:US
Mailing Address - Phone:904-398-6461
Mailing Address - Fax:904-398-3177
Practice Address - Street 1:3457 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5307
Practice Address - Country:US
Practice Address - Phone:904-398-6461
Practice Address - Fax:904-398-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 00074891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty