Provider Demographics
NPI:1497883284
Name:PATEL, BONNIE PRITI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:PRITI
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 1:1795 W STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5290
Mailing Address - Country:US
Mailing Address - Phone:734-761-2144
Mailing Address - Fax:734-662-4156
Practice Address - Street 1:1795 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5290
Practice Address - Country:US
Practice Address - Phone:734-761-2144
Practice Address - Fax:734-662-4156
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist