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General NPI Number Information
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NPI Number | 1568513760
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Entity Type | Individual
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Provider Name | DR. KHALIL J ORSBORN
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2262 DUNN AVE STE 4 SUITE #4
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4720
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Country | US
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Telephone | 904-745-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 LEGION DR
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City | COLUMBIA
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State | SC
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Zip | 29229-9561
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Country | US
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Telephone | 803-699-8196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN17320
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License Number State | FL
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