Provider Demographics
NPI:1679638480
Name:PATEL, BHARAT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHARAT
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 1:17223 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-2407
Mailing Address - Country:US
Mailing Address - Phone:602-866-0420
Mailing Address - Fax:602-866-0716
Practice Address - Street 1:17223 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-2407
Practice Address - Country:US
Practice Address - Phone:602-866-0420
Practice Address - Fax:602-866-0716
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist