Provider Demographics
NPI:1902214497
Name:PATEL, JAYSHREE ASHWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYSHREE
Middle Name:ASHWIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 TIMUQUANA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8049
Mailing Address - Country:US
Mailing Address - Phone:904-771-0933
Mailing Address - Fax:904-771-0907
Practice Address - Street 1:5310 TIMUQUANA RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8049
Practice Address - Country:US
Practice Address - Phone:904-771-0933
Practice Address - Fax:904-771-0907
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00099541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720030364OtherNPI TYPE 2
FL63060OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL073053000Medicaid
FL786435OtherUCCI