Provider Demographics
NPI:1033235734
Name:PATEL, AMISH B (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMISH
Middle Name:B
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 1:17081 W GREENWAY RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-9612
Mailing Address - Country:US
Mailing Address - Phone:623-546-8400
Mailing Address - Fax:
Practice Address - Street 1:17081 W GREENWAY RD
Practice Address - Street 2:SUITE 121
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-9612
Practice Address - Country:US
Practice Address - Phone:623-546-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124131223G0001X
AZD82081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice