Active NPI
Sergio Julio Jacas, D.M.D
- Dentist
- Fort Lauderdale, FL
National Provider Identifier
1184004228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN21198
- Practice address
- 1720 SW 47TH Ave
Fort Lauderdale, FL 33317-5619 - Phone
- (954) 615-7964
- NPI assigned
- Jun 3, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN21198 | FL | Primary |
| General Practice Dentistry | 1223G0001X | DN21198 | FL |
Addresses
Primary practice location
1720 SW 47TH Ave
Fort Lauderdale, FL 33317-5619
Mailing address
1720 SW 47TH Ave
Fort Lauderdale, FL 33317-5619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN21198 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sergio Jacas DMD LLC | Dentist | Current | Accepting new patients |
| Supreme Dental Care LLC | Current | Accepting new patients |
Networks
- HealthSun Health Plans Network
- Freedom Health HMO Network
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Tamarac, FL
- NPI 1104522812
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433289600000",
"number": "1184004228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 SW 47TH AVE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333175619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 SW 47TH AVE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333175619",
"telephone_number": "954-615-7964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACAS",
"first_name": "SERGIO",
"middle_name": "JULIO",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-03",
"last_updated": "2015-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN21198",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN21198",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.