MEDICARE: DR. ORRIN DWIGHT MITCHELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6224	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487736567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ORRIN DWIGHT MITCHELL DDS

Provider Business Mailing Address
First Line	:	1190 EDGEWOOD AVENUE WEST
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3419
Country	:	US
Telephone Number	:	904-766-6000
Fax Number	:	904-766-6003

Provider Business Practice Location Address
First Line	:	1190 WEST EDGEWOOD AVENUE
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3419
Country	:	US
Telephone Number	:	904-766-6000
Fax Number	:	904-766-6003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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