Provider Demographics
NPI:1174506794
Name:PATEL, TULSIDAS (BDS)
Entity Type:Individual
Prefix:DR
First Name:TULSIDAS
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6021
Mailing Address - Country:US
Mailing Address - Phone:423-282-0042
Mailing Address - Fax:423-282-4096
Practice Address - Street 1:1720 W MARKET ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6021
Practice Address - Country:US
Practice Address - Phone:423-282-0042
Practice Address - Fax:423-282-4096
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS30541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice