Basil Jan

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

28716 Issued in FL

Practice address

5491 Dolphin Point Blvd
Jacksonville, FL 32211-3221

Phone

(904) 312-0960

NPI assigned

Jun 22, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1184468357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7170 SW 22ND ST",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333177122",
            "telephone_number": "904-312-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5491 DOLPHIN POINT BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322113221",
            "telephone_number": "904-312-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAN",
        "first_name": "BASIL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-22",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN28716",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "28716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie H. Kopp
• Mar Jaminal, M.D.
• James Carper Jamison, M.D.
• Jammr Mobile Lab LLC
• Robert Prior Jamplis, MD
• Meryam Jan, M.D.
• Carlie Janeczko
• Janet a Betchkal MD PA
• Janet D. Constantine PL
• Janet M. Mint, O.D., PA

• Orthodontics and Dentofacial Orthopedics Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.