Healthcare Provider Details

I. General information

NPI: 1972500908
Provider Name (Legal Business Name): ORTHODONTIC OPTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3457 HENDRICKS AVE
JACKSONVILLE FL
32207-5307
US

IV. Provider business mailing address

3457 HENDRICKS AVE
JACKSONVILLE FL
32207-5307
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-6461
  • Fax: 904-398-3177
Mailing address:
  • Phone: 904-398-6461
  • Fax: 904-398-3177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 0007489
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES A. FRANK
Title or Position: ORTHODONTIST
Credential: D.M.D.
Phone: 904-398-6461