MEDICARE: DR. JAISRI R THOPPAY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	125Q00000X	Oral Medicine Dentistry	0411000055	VA
2	122300000X	Dentist	DN24372	FL
3	122300000X	Dentist	0401416527	VA
4	122300000X	Dentist	0411000055	VA
5	1223X2210X	Orofacial Pain Dentistry	DN24372	FL
6	1223X2210X	Orofacial Pain Dentistry	0401416527	VA
7	1223X2210X	Orofacial Pain Dentistry	0411000055	VA
8	125Q00000X	Oral Medicine Dentistry	DN24372	FL
9	125Q00000X	Oral Medicine Dentistry	0401416527	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LX668	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1740629088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAISRI R THOPPAY DDS

Provider Business Mailing Address
First Line	:	7151 UNIVERSITY BLVD UNIT 110
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-6724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7151 UNIVERSITY BLVD UNIT 110
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-6724
Country	:	US
Telephone Number	:	407-664-6999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	12/30/2019

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Directions to “ DR. JAISRI R THOPPAY DDS” Practice Location

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