Provider Demographics
NPI:1114485307
Name:PATEL, PUJA SATISH (DMD)
Entity Type:Individual
Prefix:
First Name:PUJA
Middle Name:SATISH
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 1:787 W LUMSDEN ROAD
Mailing Address - Street 2:FAMILY IMPLANT AND COSMETIC DENTISTRY
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-684-7888
Mailing Address - Fax:813-684-4568
Practice Address - Street 1:787 W LUMSDEN ROAD
Practice Address - Street 2:FAMILY IMPLANT AND COSMETIC DENTISTRY
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-684-7888
Practice Address - Fax:813-684-4568
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN248091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice