Provider Demographics
NPI:1457493538
Name:PATEL, DISHA GIRISH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DISHA
Middle Name:GIRISH
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 1:7803 155TH PL N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1862
Mailing Address - Country:US
Mailing Address - Phone:561-743-2323
Mailing Address - Fax:772-778-6944
Practice Address - Street 1:6200 20TH ST
Practice Address - Street 2:SUITE 292
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1012
Practice Address - Country:US
Practice Address - Phone:778-778-5773
Practice Address - Fax:772-778-6944
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17185122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice