Mandarin South Dentistry PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN9317 Issued in FL

Legal business name

MANDARIN SOUTH DENTISTRY PA

Practice address

12421 San Jose Blvd Ste 2a
Jacksonville, FL 32223-8663

Phone

(904) 268-7552

Fax

(904) 268-9792

NPI assigned

Nov 21, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Nanjappa Shivashanakr, DDS

Title

President

Phone

(904) 268-7552

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nanjappa Shivashankar, DDS

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1093854168
  NPD (past)

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479686400000",
    "number": "1699218800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12421 SAN JOSE BLVD STE 2A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238663",
            "telephone_number": "904-268-7552",
            "fax_number": "904-268-9792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12421 SAN JOSE BLVD STE 2A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238663",
            "telephone_number": "904-268-7552",
            "fax_number": "904-268-9792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDARIN SOUTH DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2016-11-21",
        "status": "A",
        "authorized_official_last_name": "SHIVASHANAKR",
        "authorized_official_first_name": "NANJAPPA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-268-7552",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN9317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "12",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mandarin Eyecare Assoc, Inc
• Mandarin Family Medicine, P.a.
• Mandarin Healing Center Inc
• Mandarin OB-GYN PA
• Mandarin Reading Clinic
• Mandarin Vision Center Inc
• David M. Mandel, MD
• Kendall Mandt, RBT
• Sherlie Mane
• Lishen Angelie Maneja

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.