Provider Demographics
NPI:1407417025
Name:PATEL, GOPALI
Entity Type:Individual
Prefix:
First Name:GOPALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 PLEASANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7839
Mailing Address - Country:US
Mailing Address - Phone:803-396-0400
Mailing Address - Fax:
Practice Address - Street 1:1751 PLEASANT RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7839
Practice Address - Country:US
Practice Address - Phone:803-396-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-07-31
Deactivation Date:2019-06-25
Deactivation Code:
Reactivation Date:2019-07-31
Provider Licenses
StateLicense IDTaxonomies
SC9407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist