Provider Demographics
NPI:1164077327
Name:PATEL, KOMAL (DMD)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
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 1:14001 SUMMIT SIERRA BLVD UNIT 2277
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-9340
Mailing Address - Country:US
Mailing Address - Phone:847-542-3345
Mailing Address - Fax:
Practice Address - Street 1:14001 SUMMIT SIERRA BLVD UNIT 2277
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-9340
Practice Address - Country:US
Practice Address - Phone:847-542-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35469122300000X
NVS3-353C1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist