Healthcare Provider Details

I. General information

NPI: 1053652412
Provider Name (Legal Business Name): MITCHELL R LEVINE DMD, PA, NORTH FLORIDA ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CARDINAL POINT DR
JACKSONVILLE FL
32257-5581
US

IV. Provider business mailing address

3600 CARDINAL POINT DR
JACKSONVILLE FL
32257-5581
US

V. Phone/Fax

Practice location:
  • Phone: 904-737-4626
  • Fax: 904-737-2126
Mailing address:
  • Phone: 904-737-4626
  • Fax: 904-737-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA TUNSTILL CREWS
Title or Position: ORTHODONTIST
Credential: DMD, MS
Phone: 904-737-4626