Individual provider Active NPI

Deshaydia Boykin, DMD

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1720496144
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 20821 Issued in FL
Practice address
5149 Normandy Blvd Unit 4
Jacksonville, FL 32205-4861
Phone
(904) 781-1201
Fax
(904) 781-4625
NPI assigned
Jul 29, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN 20821 FL Primary

Addresses

Primary practice location

5149 Normandy Blvd Unit 4
Jacksonville, FL 32205-4861

Mailing address

25 Knight Boxx Rd Apt 8204
Orange Park, FL 32065-8048

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160223002315 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9537464953

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 20821FLMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1720496144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 KNIGHT BOXX RD APT 8204",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320658048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5149 NORMANDY BLVD UNIT 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322054861",
            "telephone_number": "904-781-1201",
            "fax_number": "904-781-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYKIN",
        "first_name": "DESHAYDIA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-29",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 20821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.