MEDICARE: DR. JAYSHREE ASHWIN PATEL 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	1223G0001X	General Practice Dentistry	DN0009954	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720030364	OTHER		NPI TYPE 2
2	63060	OTHER	FL	BLUE CROSS BLUE SHIELD OF FLORIDA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	786435	OTHER	FL	UCCI

General Provider Information

NPI Number	:	1902214497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYSHREE ASHWIN PATEL DDS

Provider Business Mailing Address
First Line	:	5310 TIMUQUANA RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8049
Country	:	US
Telephone Number	:	904-771-0933
Fax Number	:	904-771-0907

Provider Business Practice Location Address
First Line	:	5310 TIMUQUANA RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8049
Country	:	US
Telephone Number	:	904-771-0933
Fax Number	:	904-771-0907

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/28/2014

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