1083999114 NPI number — ORRIN D. MITCHELL, D.D.S., P.A.

Table of content: (NPI 1083999114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083999114 NPI number — ORRIN D. MITCHELL, D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORRIN D. MITCHELL, D.D.S., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083999114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1190 EDGEWOOD AVE W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32208-3419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-766-6000
Provider Business Mailing Address Fax Number:
904-766-6003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1190 EDGEWOOD AVE W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32208-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-766-6000
Provider Business Practice Location Address Fax Number:
904-766-6003
Provider Enumeration Date:
10/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
ORRIN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
904-766-6000

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DN 6224 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com