Provider Demographics
NPI:1396177903
Name:PATEL, DIVYESH R (DMD)
Entity Type:Individual
Prefix:
First Name:DIVYESH
Middle Name:R
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 1:284 BOUGAINVILLEA LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-4123
Mailing Address - Country:US
Mailing Address - Phone:551-580-2016
Mailing Address - Fax:
Practice Address - Street 1:95-1249 MEHEULA PKWY STE 115
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1786
Practice Address - Country:US
Practice Address - Phone:551-580-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293631223G0001X
HI25521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice