Jeremiah D. Patrick, D.M.D., P.A.
Dentist, Endodontics in Fort Walton Beach, FL. Organization (NPI-2).
NPI number1154096097
StatusActive
Last updated in NPPESFeb 2, 2026
Details
- NPI
- 1154096097
- Entity type
- Organization (NPI-2)
- Legal business name
- Jeremiah D. Patrick, D.M.D., P.A.
- Organization subpart
- No
- Enumeration date
- Aug 12, 2021
- Certification date
- Feb 2, 2026
- Last updated
- Feb 2, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223E0200X | Dentist, Endodontics | – | – | Yes |
Other names
- Patrick Endodontics (Doing Business As)
Practice location
207 Pelham RdFort Walton Beach, FL 32547-3604
Phone 850-808-3636
Mailing address
207 Pelham RdFort Walton Beach, FL 32547-3604
Phone 850-808-3636
Authorized official
Jeremiah Daniel Patrick
Ceo
8508083636
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