Provider Demographics
NPI:1891753711
Name:CAGATA, JAY C (DMD,MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:CAGATA
Suffix:
Gender:M
Credentials:DMD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 SE SANTA BARBARA PL # 101
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-2709
Mailing Address - Country:US
Mailing Address - Phone:239-574-3323
Mailing Address - Fax:239-574-2381
Practice Address - Street 1:2534 SE SANTA BARBARA PL # 101
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904
Practice Address - Country:US
Practice Address - Phone:239-574-3323
Practice Address - Fax:239-574-2381
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00144241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG59969Medicare UPIN
FL56812Medicare ID - Type Unspecified