1427695741 NPI number — JONESVILLE FAMILY DENTISTRY PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427695741 NPI number — JONESVILLE FAMILY DENTISTRY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONESVILLE FAMILY DENTISTRY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427695741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 NW 138TH TERRACE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
JONESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-332-3080
Provider Business Mailing Address Fax Number:
352-333-3729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 NW 138TH TERRACE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JONESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-332-3080
Provider Business Practice Location Address Fax Number:
352-333-3729
Provider Enumeration Date:
12/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NERIKAR
Authorized Official First Name:
VIVEK
Authorized Official Middle Name:
Authorized Official Title or Position:
DMD-DENTIST OWNER
Authorized Official Telephone Number:
904-553-4859

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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