Provider Demographics
NPI:1003956921
Name:PATEL, BHASKER C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHASKER
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 SAXON BLVD STE 39
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8209
Mailing Address - Country:US
Mailing Address - Phone:386-775-1001
Mailing Address - Fax:386-775-3050
Practice Address - Street 1:870 SAXON BLVD STE 39
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8209
Practice Address - Country:US
Practice Address - Phone:386-775-1001
Practice Address - Fax:386-775-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN09473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist