Provider Demographics
NPI:1043415870
Name:PATEL, ASHISH A (MD, DDS,FACS)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, DDS,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 NW KEARNEY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1453
Mailing Address - Country:US
Mailing Address - Phone:503-224-1371
Mailing Address - Fax:
Practice Address - Street 1:1849 NW KEARNEY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-224-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10370204E00000X
ORMD161538204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery