Active NPI
Jay Anjankumar Mistry, DDS
- General Practice Dentistry
- Nevada, MO
National Provider Identifier
1750940862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2020015672
- Practice address
- 204 N Cedar St
Nevada, MO 64772-2310 - Phone
- (844) 853-8937
- NPI assigned
- Jun 12, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30.025824 | OH | |
| General Practice Dentistry | 1223G0001X | 2020015672 | MO | Primary |
Addresses
Primary practice location
204 N Cedar St
Nevada, MO 64772-2310
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30.025824 | Other | OH | STATE LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.gorefreshdental.com/locations/refresh-dental-toledo-talmadge/ | Direct |
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 |
|---|---|---|---|
| 2020015672 | MO | MD | General Practice Dentistry |
| 30.025824 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1750940862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 COMMUNITY",
"city": "CLINTON",
"state": "MO",
"postal_code": "647358804",
"telephone_number": "660-885-8131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 N CEDAR ST",
"city": "NEVADA",
"state": "MO",
"postal_code": "647722310",
"telephone_number": "844-853-8937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISTRY",
"first_name": "JAY",
"middle_name": "ANJANKUMAR",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-12",
"last_updated": "2023-11-27",
"certification_date": "2020-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "30.025824",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2020015672",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "30.025824",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.gorefreshdental.com/locations/refresh-dental-toledo-talmadge/",
"affiliation": "Y",
"endpointDescription": "practice website",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "practice website",
"address_1": "4321 Talmadge Rd",
"city": "Toledo",
"state": "OH",
"country_code": "US",
"postal_code": "436233539",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Nevada, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.