Provider Demographics
NPI:1144543372
Name:PATEL, ANJALI PURI (DMD)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:PURI
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 1:613 E GRADY ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5104
Mailing Address - Country:US
Mailing Address - Phone:912-259-9543
Mailing Address - Fax:912-259-9544
Practice Address - Street 1:613 E GRADY ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5104
Practice Address - Country:US
Practice Address - Phone:912-259-9543
Practice Address - Fax:012-259-9544
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist