Provider Demographics
NPI:1659052702
Name:PATEL, RAVI SANJAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:SANJAY
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 1:815 REELFOOT DR
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1651
Mailing Address - Country:US
Mailing Address - Phone:731-334-2890
Mailing Address - Fax:
Practice Address - Street 1:95 US HIGHWAY 51 BYP W
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1935
Practice Address - Country:US
Practice Address - Phone:731-286-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN123041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice