Jeremiah Daniel Patrick, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN24125 Issued in FL

Practice address

207 Pelham Rd
Fort Walton Beach, FL 32547-3604

Phone

(850) 808-3636

NPI assigned

Aug 4, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 31, 2024 through May 31, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jeremiah D. Patrick, D.M.D., P.a.

  • Endodontics
  • Fort Walton Beach, FL
  • NPI 1154096097
  NPD Authorized official

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

{
    "created_epoch": "1564876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1841845161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 PELHAM RD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325473604",
            "telephone_number": "850-808-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 PELHAM RD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325473604",
            "telephone_number": "850-808-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "JEREMIAH",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-04",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN24125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna C Pate, PHARM.D
• Amit Patel, MD
• Charmy Hiteshbhai Patel
• Jaimin Patel, M.D
• Patricia Harrison MD P L
• Patriotmed of Kansas, P.a.
• Paul J Kalin
• Charlotte Paulk, MED CF SLP
• Christopher Peter Paulson, M.D.
• Maria Nichole Pavone, APRN

• Endodontics in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Endodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.