Provider Demographics
NPI:1619386711
Name:PATEL, MOHINI RESHMA BHARAT
Entity Type:Individual
Prefix:
First Name:MOHINI RESHMA BHARAT
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:859-626-7700
Mailing Address - Fax:859-626-7890
Practice Address - Street 1:116 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-8590
Practice Address - Country:US
Practice Address - Phone:606-256-2143
Practice Address - Fax:606-256-9762
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY94681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice