Provider Demographics
NPI:1538659172
Name:PATEL, MAITRY DARPAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAITRY
Middle Name:DARPAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MAITRY
Other - Middle Name:MAHENDRA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11017 N DALE MABRY HWY STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3873
Mailing Address - Country:US
Mailing Address - Phone:813-968-7228
Mailing Address - Fax:
Practice Address - Street 1:11017 N DALE MABRY HWY STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3873
Practice Address - Country:US
Practice Address - Phone:813-968-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23319122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist