Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mandarin South Dentistry PA

Organization Dentist · NPI 1699218800

Mandarin South Dentistry PA provides Dentist services in Jacksonville, Florida. Licensed in Florida. Registered with an NPI since 2016.

Licensed in
FL
In the registry since
2016
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12421 San Jose Blvd Ste 2A
Jacksonville, FL 32223-8663
Phone: (904) 268-7552
Fax: (904) 268-9792
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN9317 (FL)

Record details

NPI number1699218800
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Nanjappa Shivashanakr — President · (904) 268-7552
NPI enumeratedNovember 21, 2016
Last updated in NPPESNovember 21, 2016
Mailing address12421 San Jose Blvd Ste 2a, Jacksonville, FL 32223-8663

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