Provider Demographics
NPI:1558688309
Name:PATEL, STAVAN YOGENDRA (DDS, MD)
Entity Type:Individual
Prefix:
First Name:STAVAN
Middle Name:YOGENDRA
Last Name:PATEL
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Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF ORAL SURGERY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-813-2625
Mailing Address - Fax:318-813-2527
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF ORAL SURGERY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-2625
Practice Address - Fax:318-813-2527
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXU0177204E00000X
LAMD.302913204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery