Provider Demographics
NPI:1073951695
Name:PATEL, RIDDHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:RIDDHI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RIDDHIBEN
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:481 MUNN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0014
Mailing Address - Country:US
Mailing Address - Phone:704-323-5390
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:481 MUNN RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-0014
Practice Address - Country:US
Practice Address - Phone:704-323-5390
Practice Address - Fax:513-585-5511
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039577122300000X
SC100601223G0001X
OH30025544204E00000X
390200000X
SC100621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program