Provider Demographics
NPI:1093061400
Name:PATEL, JIGNESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIGNESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 BRETTUNGAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-5503
Mailing Address - Country:US
Mailing Address - Phone:954-551-4624
Mailing Address - Fax:
Practice Address - Street 1:6144 GAZEBO PARK PL S STE 210
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-262-9466
Practice Address - Fax:904-268-8648
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19907122300000X
FLDN19907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812750812OtherTAX ID