Provider Demographics
NPI:1164950101
Name:PATEL, BRITTANIE LEE (DDS)
Entity Type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:LEE
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BRITTANIE
Other - Middle Name:LEE
Other - Last Name:IZSAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:421 CHADWICK CIR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8080
Mailing Address - Country:US
Mailing Address - Phone:219-508-4935
Mailing Address - Fax:
Practice Address - Street 1:1001 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4126
Practice Address - Country:US
Practice Address - Phone:219-462-7173
Practice Address - Fax:219-462-7504
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012718A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300003140Medicaid