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General NPI Number Information
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NPI Number | 1083999114
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Entity Type | Organization
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Legal Business Name | ORRIN D. MITCHELL, D.D.S., P.A.
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 1190 EDGEWOOD AVE W SUITE A
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City | JACKSONVILLE
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State | FL
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Zip | 32208-3419
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Country | US
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Telephone | 904-766-6000
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Fax | 904-766-6003
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Provider Business Mailing Address
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Address Line | 1190 EDGEWOOD AVE W SUITE A
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City | JACKSONVILLE
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State | FL
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Zip | 32208-3419
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Country | US
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Telephone | 904-766-6000
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Fax | 904-766-6003
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ORRIN D. MITCHELL
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Credential | D.D.S.
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Telephone | 904-766-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN 6224
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License Number State | FL
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