Provider Demographics
NPI:1871685800
Name:PATEL, SUSHIL (BDS, DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2306
Mailing Address - Country:US
Mailing Address - Phone:407-814-4940
Mailing Address - Fax:407-814-4875
Practice Address - Street 1:1450 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2306
Practice Address - Country:US
Practice Address - Phone:407-814-4940
Practice Address - Fax:407-814-4875
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010189321223G0001X
FLDN184201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001037900Medicaid