Provider Demographics
NPI:1477670115
Name:PATEL, YAGNABALA KAMAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAGNABALA
Middle Name:KAMAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YAGI
Other - Middle Name:K
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:109 S ATLANTIC DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1937
Mailing Address - Country:US
Mailing Address - Phone:561-306-2646
Mailing Address - Fax:
Practice Address - Street 1:5851 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1347
Practice Address - Country:US
Practice Address - Phone:561-965-9988
Practice Address - Fax:561-965-0385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice