Provider Demographics
NPI:1740629088
Name:THOPPAY, JAISRI R (DDS)
Entity type:Individual
Prefix:DR
First Name:JAISRI
Middle Name:R
Last Name:THOPPAY
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 1:7151 UNIVERSITY BLVD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7151 UNIVERSITY BLVD UNIT 110
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6724
Practice Address - Country:US
Practice Address - Phone:407-664-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0411000055125Q00000X, 122300000X, 1223X2210X
FLDN24372122300000X, 1223X2210X, 125Q00000X
VA0401416527122300000X, 1223X2210X, 125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No125Q00000XDental ProvidersDentistOral Medicine
No1223X2210XDental ProvidersDentistOrofacial Pain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLX668OtherMEDICARE PTAN