Provider Demographics
NPI:1457505356
Name:PATEL, MANIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANIKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14122 W MCDOWELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2505
Mailing Address - Country:US
Mailing Address - Phone:318-617-6440
Mailing Address - Fax:318-210-0800
Practice Address - Street 1:2005 MEADOW BND
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4852
Practice Address - Country:US
Practice Address - Phone:318-617-6440
Practice Address - Fax:318-210-0800
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice