Provider Demographics
NPI:1881262319
Name:PATEL, JAI DEV DHIRENDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:JAI DEV
Middle Name:DHIRENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 CLEAR RIVER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1431
Mailing Address - Country:US
Mailing Address - Phone:407-497-6581
Mailing Address - Fax:
Practice Address - Street 1:8015 TURKEY LAKE RD STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7383
Practice Address - Country:US
Practice Address - Phone:407-205-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist