NPIMap

Organization Active NPI

Jayshree a. Patel DDS PA

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1720030364
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN0009954 Issued in FL
Legal business name
JAYSHREE A. PATEL DDS PA
Practice address
5310 Timuquana Rd
Jacksonville, FL 32210-8049
Phone
(904) 771-0933
Fax
(904) 771-0907
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Jayshree Ashwin Patel, DDSNPI 1902214497
Title
President
Phone
(904) 771-0933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN0009954 FL Primary

Addresses

Primary practice location

5310 Timuquana Rd
Jacksonville, FL 32210-8049

Mailing address

5310 Timuquana Rd
Jacksonville, FL 32210-8049
Phone (904) 771-0933

Other identifiers 3

IdentifierTypeStateIssuer
073053000MedicaidFL
786435OtherFLUNITED CONCORDIA
63060OtherFLBC/BS

Other names 1

  • Jayshree A. Patel DDS Former legal business name

National Provider Directory

National Provider Directory

Locations

5310 Timuquana Rd
Jacksonville, FL 32210
Phone (904) 771-0933

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1720030364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 TIMUQUANA RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322108049",
            "telephone_number": "904-771-0933",
            "fax_number": "904-771-0907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 TIMUQUANA RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322108049",
            "telephone_number": "904-771-0933",
            "fax_number": "904-771-0907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAYSHREE A. PATEL DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "JAYSHREE",
        "authorized_official_middle_name": "ASHWIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-771-0933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0009954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "073053000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "786435",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "63060",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jayshree A. Patel DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.