Provider Demographics
NPI:1639198401
Name:PATEL, PARESH B (DDS)
Entity Type:Individual
Prefix:
First Name:PARESH
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5721
Mailing Address - Country:US
Mailing Address - Phone:828-754-7881
Mailing Address - Fax:828-754-5391
Practice Address - Street 1:310 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5721
Practice Address - Country:US
Practice Address - Phone:828-754-7881
Practice Address - Fax:828-754-5391
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899008AMedicaid
NC899008CMedicaid