Provider Demographics
NPI:1164976718
Name:PATEL, VIVEK (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7383
Mailing Address - Country:US
Mailing Address - Phone:843-642-8100
Mailing Address - Fax:843-566-0706
Practice Address - Street 1:1101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7383
Practice Address - Country:US
Practice Address - Phone:843-642-8100
Practice Address - Fax:843-566-0706
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist