Provider Demographics
NPI:1932316965
Name:S. A. PATEL D.D.S., P.A.
Entity Type:Organization
Organization Name:S. A. PATEL D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHASHCHANDRA
Authorized Official - Middle Name:AMBALAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-669-7564
Mailing Address - Street 1:1025 10TH AVE. BOX 676
Mailing Address - Street 2:
Mailing Address - City:CLARKFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56223-0676
Mailing Address - Country:US
Mailing Address - Phone:320-669-7564
Mailing Address - Fax:
Practice Address - Street 1:1025 10TH AVE. BOX 676
Practice Address - Street 2:
Practice Address - City:CLARKFIELD
Practice Address - State:MN
Practice Address - Zip Code:56223-0676
Practice Address - Country:US
Practice Address - Phone:320-669-7564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR SA PATEL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-17
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN983217300Medicaid
MN983217300Medicaid