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 is a Dentist 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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