Provider Demographics
NPI:1336475706
Name:PATEL, KINNARI (DDS)
Entity Type:Individual
Prefix:
First Name:KINNARI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HAVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8682
Mailing Address - Country:US
Mailing Address - Phone:650-521-2124
Mailing Address - Fax:
Practice Address - Street 1:7171 NOLENSVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9461
Practice Address - Country:US
Practice Address - Phone:650-521-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 601054981223G0001X
TN99051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice