Organization
MANDARIN SOUTH DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANJAPPA SHIVASHANAKR DDS (PRESIDENT)
(904) 268-7552
Entity
Organization
Contact information
Practice address
12421 SAN JOSE BLVD STE 2A, JACKSONVILLE, FL 32223-8663
(904) 268-7552
(904) 268-9792
Mailing address
12421 SAN JOSE BLVD STE 2A, JACKSONVILLE, FL 32223-8663
(904) 268-7552
(904) 268-9792
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN9317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12
DENTIST
FL
Enumeration date
11/21/2016
Last updated
11/21/2016
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