Provider Demographics
NPI:1790005650
Name:PATEL, JAYRAJ JASHWANTLAL (DMD)
Entity Type:Individual
Prefix:
First Name:JAYRAJ
Middle Name:JASHWANTLAL
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 1:5881 PEARL ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8520
Mailing Address - Country:US
Mailing Address - Phone:813-842-5837
Mailing Address - Fax:
Practice Address - Street 1:150 MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-8644
Practice Address - Country:US
Practice Address - Phone:386-738-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice