Provider Demographics
NPI:1043205354
Name:PATEL, PAYAL MANU (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:MANU
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15580 3RD AVE SW
Mailing Address - Street 2:STE 102
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-4566
Mailing Address - Country:US
Mailing Address - Phone:206-753-7114
Mailing Address - Fax:
Practice Address - Street 1:33600 6TH AVE S
Practice Address - Street 2:102
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6743
Practice Address - Country:US
Practice Address - Phone:253-838-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000108831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice