Provider Demographics
NPI:1861689507
Name:MANISHA DESAI PATEL DDS
Entity Type:Organization
Organization Name:MANISHA DESAI PATEL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-754-7881
Mailing Address - Street 1:310 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645
Mailing Address - Country:US
Mailing Address - Phone:828-754-7881
Mailing Address - Fax:828-754-5391
Practice Address - Street 1:310 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5721
Practice Address - Country:US
Practice Address - Phone:828-754-7881
Practice Address - Fax:828-754-5391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANISHA DESAI PATEL DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6771122300000X
NC63321223G0001X
NC81541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899008CMedicaid
NC5905741Medicaid
NC899008AMedicaid