Provider Demographics
NPI:1225724545
Name:PATEL, DESHEK (DMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:DESHEK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 STEINBECK PL
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0759
Mailing Address - Country:US
Mailing Address - Phone:813-928-1068
Mailing Address - Fax:
Practice Address - Street 1:3885 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1109
Practice Address - Country:US
Practice Address - Phone:863-333-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN251401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics