Provider Demographics
NPI:1679766570
Name:PATEL, BHARTI B (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHARTI
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 WELLS RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2336
Mailing Address - Country:US
Mailing Address - Phone:904-278-9011
Mailing Address - Fax:
Practice Address - Street 1:1580 WELLS RD
Practice Address - Street 2:SUITE 20
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2336
Practice Address - Country:US
Practice Address - Phone:904-278-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL121891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice