Provider Demographics
NPI:1609278894
Name:PATEL, VINIT A (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINIT
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 LANCASTER DR NE
Mailing Address - Street 2:STE 104
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1040
Mailing Address - Country:US
Mailing Address - Phone:503-587-9949
Mailing Address - Fax:
Practice Address - Street 1:2815 WILLETTA ST SW
Practice Address - Street 2:SUITE A-1
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3470
Practice Address - Country:US
Practice Address - Phone:541-512-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD101321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice