Provider Demographics
NPI:1891808119
Name:PATEL, AMIT PRAVIN (DMD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:PRAVIN
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17605 HACKAMORE PLACE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5685
Mailing Address - Country:US
Mailing Address - Phone:813-949-0215
Mailing Address - Fax:813-933-6875
Practice Address - Street 1:17605 HACKAMORE PLACE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5685
Practice Address - Country:US
Practice Address - Phone:813-949-0215
Practice Address - Fax:813-933-6875
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16808122300000X
GADN012956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist