Provider Demographics
NPI:1114596491
Name:PATEL, MITESH ASHOKBHAI (DDS)
Entity Type:Individual
Prefix:
First Name:MITESH
Middle Name:ASHOKBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4207
Mailing Address - Country:US
Mailing Address - Phone:502-491-0054
Mailing Address - Fax:502-491-9618
Practice Address - Street 1:2010 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4207
Practice Address - Country:US
Practice Address - Phone:502-491-0054
Practice Address - Fax:502-491-9618
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice