Provider Demographics
NPI:1467187005
Name:PATEL, TANUSHA P (DMD)
Entity Type:Individual
Prefix:
First Name:TANUSHA
Middle Name:P
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 1:532 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8243
Mailing Address - Country:US
Mailing Address - Phone:919-576-6458
Mailing Address - Fax:
Practice Address - Street 1:458 OLD CHEROKEE RD STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6971
Practice Address - Country:US
Practice Address - Phone:803-500-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist