Provider Demographics
NPI:1659463933
Name:PATEL, JAYESH S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYESH
Middle Name:S
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 1:2511 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8944
Mailing Address - Country:US
Mailing Address - Phone:254-741-9324
Mailing Address - Fax:254-752-2444
Practice Address - Street 1:2511 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8944
Practice Address - Country:US
Practice Address - Phone:254-741-9324
Practice Address - Fax:254-752-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20615122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist