Active NPI
Anju Jain, DDS
- General Practice Dentistry
- Kissimmee, FL
National Provider Identifier
1952654576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN19953
- Practice address
- 109 N Doverplum Ave
Kissimmee, FL 34758-3309 - Phone
- (407) 943-8600
- NPI assigned
- Oct 19, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN19953 | FL | Primary |
Addresses
Primary practice location
109 N Doverplum Ave
Kissimmee, FL 34758-3309
Mailing address
1503 Bill Beck Blvd
Kissimmee, FL 34744-9516
Phone (407) 943-8600
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220216002581 | FL | Order and Referring Only - Dentist | 6103219027 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN19953 | FL | MD | General Practice Dentistry |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739318400000",
"number": "1952654576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1503 BILL BECK BLVD",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347449516",
"telephone_number": "407-943-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 N DOVERPLUM AVE",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347583309",
"telephone_number": "407-943-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAIN",
"first_name": "ANJU",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-19",
"last_updated": "2025-02-12",
"certification_date": "2025-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN19953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.