Patriot Family Dental PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PATRIOT FAMILY DENTAL PA

Practice address

8823 Goodbys Executive Dr
Jacksonville, FL 32217-4605

Phone

(470) 336-2612

NPI assigned

Oct 20, 2025

Last updated

Mar 6, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Christopher Wiman, DMDNPI 1811303183

Title

President

Phone

(904) 731-0432

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Christopher Wiman, DMD

  • Dentist
  • Jacksonville, FL
  • NPI 1811303183
  NPD Authorized official
• Stefan Nicholas Stroh, DMD

  • Student in an Organized Health Care Education/Training Program
  • Gainesville, FL
  • NPI 1851964001
  NPD
• Joseph Robert Boulter, DMD

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1053381632
  NPD (past)

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

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772755200000",
    "number": "1982571584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 GOODBYS EXECUTIVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174605",
            "telephone_number": "904-731-0432",
            "fax_number": "904-731-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8823 GOODBYS EXECUTIVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174605",
            "telephone_number": "470-336-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOT FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-20",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A",
        "authorized_official_last_name": "WIMAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-731-0432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Patrick Taylor, M.S.
• Jennifer Ann Patrick, LPN
• Kelly L Patrick, LMHC
• Sierra Patrick
• Hayley Gant Patridge, PA-C
• Patriotmed of Kansas, P.a.
• Dana R Pattathan, APRN
• Abigail M Patterson, PSY.D
• Alaina Patterson
• Altenise Patterson

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.