Provider Demographics
NPI:1376682005
Name:JEETENDRA PATEL, DDS, A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:JEETENDRA PATEL, DDS, A PROFESSIONAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEETENDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-325-2922
Mailing Address - Street 1:3340 STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2522
Mailing Address - Country:US
Mailing Address - Phone:318-325-2922
Mailing Address - Fax:
Practice Address - Street 1:3340 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2522
Practice Address - Country:US
Practice Address - Phone:318-325-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty