Provider Demographics
NPI:1043628860
Name:PATEL, SAGAR BHARATBHAI
Entity Type:Individual
Prefix:
First Name:SAGAR
Middle Name:BHARATBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PLAYGROUND RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7658
Mailing Address - Country:US
Mailing Address - Phone:201-888-4922
Mailing Address - Fax:
Practice Address - Street 1:6420 GARNERS FERRY RD STE X
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1632
Practice Address - Country:US
Practice Address - Phone:201-888-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8438 GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice