Provider Demographics
NPI:1669813481
Name:PATEL, DISHANT MAHENDRABHAI (DDS)
Entity Type:Individual
Prefix:
First Name:DISHANT
Middle Name:MAHENDRABHAI
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:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:734-983-0128
Mailing Address - Fax:
Practice Address - Street 1:41829 FORD ROAD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-983-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0240191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1223G0001XDental ProvidersDentistGeneral Practice