MEDICARE: ORRIN D. MITCHELL, D.D.S., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DN 6224	FL

General Provider Information

NPI Number	:	1083999114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORRIN D. MITCHELL, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	1190 EDGEWOOD AVE W
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3419
Country	:	US
Telephone Number	:	904-766-6000
Fax Number	:	904-766-6003

Provider Business Practice Location Address
First Line	:	1190 EDGEWOOD AVE W
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3419
Country	:	US
Telephone Number	:	904-766-6000
Fax Number	:	904-766-6003

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. ORRIN D. MITCHELL
Credential	:	D.D.S.
Telephone Number	:	904-766-6000

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	03/27/2013

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