Provider Demographics
NPI:1861681165
Name:PATEL, BHAVISHA P (DMD)
Entity Type:Individual
Prefix:
First Name:BHAVISHA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BROADWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3200
Mailing Address - Country:US
Mailing Address - Phone:781-233-6844
Mailing Address - Fax:
Practice Address - Street 1:605 BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3200
Practice Address - Country:US
Practice Address - Phone:781-233-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist