Provider Demographics
NPI:1174852438
Name:PATEL, JAY K (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:K
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 1:25775 W 10 MILE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4856
Mailing Address - Country:US
Mailing Address - Phone:248-354-6364
Mailing Address - Fax:248-354-2486
Practice Address - Street 1:25775 W 10 MILE RD STE 104
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4856
Practice Address - Country:US
Practice Address - Phone:248-354-6364
Practice Address - Fax:248-354-2486
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821828995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist