Provider Demographics
NPI:1467668608
Name:PATEL, SMITA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 SW 320TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2567
Mailing Address - Country:US
Mailing Address - Phone:253-252-2059
Mailing Address - Fax:253-250-0305
Practice Address - Street 1:2317 SW 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2567
Practice Address - Country:US
Practice Address - Phone:253-252-2059
Practice Address - Fax:253-250-0305
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000107311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00010731OtherSTATE LICENSE