Provider Demographics
NPI:1811023872
Name:DR. BHAVNA PATEL D.D.S, P.C
Entity Type:Organization
Organization Name:DR. BHAVNA PATEL D.D.S, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-796-9488
Mailing Address - Street 1:205 PAGE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2462
Mailing Address - Country:US
Mailing Address - Phone:517-796-9488
Mailing Address - Fax:517-787-4280
Practice Address - Street 1:205 PAGE AVE
Practice Address - Street 2:STE A
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2462
Practice Address - Country:US
Practice Address - Phone:517-796-9488
Practice Address - Fax:517-787-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI146521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty