Provider Demographics
NPI:1780734251
Name:MAHAJAN, JILA J (DDS)
Entity type:Individual
Prefix:DR
First Name:JILA
Middle Name:J
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8450 PAPELON WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4313
Mailing Address - Country:US
Mailing Address - Phone:904-828-4072
Mailing Address - Fax:
Practice Address - Street 1:4411 ROOSEVELT BLVD
Practice Address - Street 2:STE 594
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3221
Practice Address - Country:US
Practice Address - Phone:904-423-1377
Practice Address - Fax:904-423-1958
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN139191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry