Provider Demographics
NPI:1053815043
Name:PATEL, KEYURKUMAR R
Entity Type:Individual
Prefix:
First Name:KEYURKUMAR
Middle Name:R
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 1:12231 E COLONIAL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4761
Mailing Address - Country:US
Mailing Address - Phone:678-633-9944
Mailing Address - Fax:
Practice Address - Street 1:12231 E COLONIAL DR STE 150
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4761
Practice Address - Country:US
Practice Address - Phone:678-633-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP1811122300000X
FLDN25145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist