Provider Demographics
NPI:1215549290
Name:PATEL FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:PATEL FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-642-2400
Mailing Address - Street 1:100 SCOTT FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7069
Mailing Address - Country:US
Mailing Address - Phone:937-642-2400
Mailing Address - Fax:937-642-2490
Practice Address - Street 1:100 SCOTT FARMS BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7069
Practice Address - Country:US
Practice Address - Phone:937-642-2400
Practice Address - Fax:937-642-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental