Provider Demographics
NPI:1447770516
Name:PATEL, MAITRI S (DMD)
Entity Type:Individual
Prefix:
First Name:MAITRI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 W COUNTY ROAD 419 STE 1010
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4428
Mailing Address - Country:US
Mailing Address - Phone:407-542-4580
Mailing Address - Fax:
Practice Address - Street 1:1884 W COUNTY ROAD 419 STE 1010
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4428
Practice Address - Country:US
Practice Address - Phone:407-542-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN225801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice