Individual provider Active NPI

Kinjalben N. Patel, DMD

  • General Practice Dentistry
  • Ormond Beach, FL
National Provider Identifier
1952716706
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 20743 Issued in FL
Practice address
1462 W Granada Blvd Ste 210
Ormond Beach, FL 32174-9167
Phone
(386) 675-1711
NPI assigned
Jun 30, 2014
Last updated
Apr 20, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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 20743 FL Primary

Addresses

Primary practice location

1462 W Granada Blvd Ste 210
Ormond Beach, FL 32174-9167

Mailing address

926 Great Pond Dr Ste 1000
Altamonte Springs, FL 32714-7244

Other identifiers 1

IdentifierTypeStateIssuer
012615800MedicaidFL

Other names 1

  • Kinjal N. Patel Other name

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
I20150530000068 FL Order and Referring Only - DentistPractitioner - Dentist 0244551463

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 20743FLMDGeneral 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": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1952716706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 GREAT POND DR STE 1000",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327147244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 W GRANADA BLVD STE 210",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321749167",
            "telephone_number": "386-675-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "KINJALBEN",
        "middle_name": "N.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-30",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 20743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012615800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KINJAL",
            "last_name": "PATEL",
            "middle_name": "N.",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ormond Beach, FL

Sources for this page

Verify at the official NPI Registry.