Provider Demographics
NPI:1225760010
Name:PATEL, ASHUTOSH DILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHUTOSH
Middle Name:DILIP
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 1:3131 CEDRIC CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-1101
Mailing Address - Country:US
Mailing Address - Phone:919-825-7219
Mailing Address - Fax:
Practice Address - Street 1:9335 BLAKENEY CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6665
Practice Address - Country:US
Practice Address - Phone:413-274-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty