Provider Demographics
NPI:1346614211
Name:OAKLEAF ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:OAKLEAF ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KOEHLER
Authorized Official - Last Name:ZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-404-4445
Mailing Address - Street 1:9640 CROSSHILL BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-5854
Mailing Address - Country:US
Mailing Address - Phone:904-404-4445
Mailing Address - Fax:
Practice Address - Street 1:9640 CROSSHILL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5854
Practice Address - Country:US
Practice Address - Phone:904-404-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty