Provider Demographics
NPI:1225760861
Name:PATEL, SUNIT (DDS)
Entity Type:Individual
Prefix:
First Name:SUNIT
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NH
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-559-5999
Mailing Address - Fax:
Practice Address - Street 1:4014 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-559-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7825OtherNEBRASKA DENTAL LICENCE