Provider Demographics
NPI:1811044035
Name:PATEL, MAHESH CHUNIBHAI (BDS)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:CHUNIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:DR
Other - First Name:MAHESH
Other - Middle Name:CHUNIBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BDS
Mailing Address - Street 1:380 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1448
Mailing Address - Country:US
Mailing Address - Phone:718-277-8289
Mailing Address - Fax:
Practice Address - Street 1:380 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1448
Practice Address - Country:US
Practice Address - Phone:718-277-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0426101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01180987Medicaid