Provider Demographics
NPI:1275225526
Name:PATEL, RAJEEV SHAH (DMD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:SHAH
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 1:7749 ROYAL CREST DR # 32256
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2345
Mailing Address - Country:US
Mailing Address - Phone:904-982-7317
Mailing Address - Fax:
Practice Address - Street 1:790 SKYMARKS DR STE 109
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7267
Practice Address - Country:US
Practice Address - Phone:904-982-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist