Healthcare Provider Details

I. General information

NPI: 1467452151
Provider Name (Legal Business Name): JACKSONVILLE UNIVERSITY SCHOOL OF ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3321
US

IV. Provider business mailing address

2800 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3321
US

V. Phone/Fax

Practice location:
  • Phone: 904-256-7847
  • Fax: 904-256-7889
Mailing address:
  • Phone: 904-256-7847
  • Fax: 904-256-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDTP449
License Number StateFL

VIII. Authorized Official

Name: DR. MARK ALARBI
Title or Position: CLINIC DIRECTOR
Credential: D.D.S.
Phone: 904-256-7847