Provider Demographics
NPI:1386833630
Name:PATEL, RAJIV R (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-8644
Mailing Address - Country:US
Mailing Address - Phone:386-738-2006
Mailing Address - Fax:386-738-2007
Practice Address - Street 1:150 MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-8644
Practice Address - Country:US
Practice Address - Phone:386-738-2006
Practice Address - Fax:386-738-2007
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 00103661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice