Provider Demographics
NPI:1750096467
Name:JU SCHOOL OF ORTHODONTICS
Entity type:Organization
Organization Name:JU SCHOOL OF ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-256-7854
Mailing Address - Street 1:5491 DOLPHIN POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3221
Mailing Address - Country:US
Mailing Address - Phone:904-256-7854
Mailing Address - Fax:
Practice Address - Street 1:5491 DOLPHIN POINT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3221
Practice Address - Country:US
Practice Address - Phone:904-256-7854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty