Provider Demographics
NPI:1922591619
Name:PATEL, PRATIK S (DMD)
Entity Type:Individual
Prefix:
First Name:PRATIK
Middle Name:S
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 1:11808 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8020
Mailing Address - Country:US
Mailing Address - Phone:732-910-7949
Mailing Address - Fax:
Practice Address - Street 1:1350 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1908
Practice Address - Country:US
Practice Address - Phone:954-385-9240
Practice Address - Fax:954-385-9260
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist