Provider Demographics
NPI:1972096998
Name:PATEL, BINAL JAGADISH
Entity Type:Individual
Prefix:
First Name:BINAL
Middle Name:JAGADISH
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S FRONT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-1657
Mailing Address - Country:US
Mailing Address - Phone:931-644-3968
Mailing Address - Fax:
Practice Address - Street 1:113 HARBOR TOWN SQ STE 203
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-8890
Practice Address - Country:US
Practice Address - Phone:901-453-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist