Provider Demographics
NPI:1386840106
Name:PATEL, SHAILESH CHAMPAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:CHAMPAK
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 1:28530 RAVENS PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0677
Mailing Address - Country:US
Mailing Address - Phone:919-906-5771
Mailing Address - Fax:919-678-9993
Practice Address - Street 1:25621 NELSON WAY STE 110
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5367
Practice Address - Country:US
Practice Address - Phone:281-392-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70911223G0001X
TX392041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice