Provider Demographics
NPI:1578012381
Name:PATEL, VAISHALIBEN (MDS)
Entity Type:Individual
Prefix:
First Name:VAISHALIBEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 TORRINGTON DR WEST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:08818-6285
Mailing Address - Country:US
Mailing Address - Phone:732-668-5063
Mailing Address - Fax:
Practice Address - Street 1:465 TORRINGTON DR W
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-6285
Practice Address - Country:US
Practice Address - Phone:732-668-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist