Provider Demographics
NPI:1972686616
Name:PATEL, SHAKU J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAKU
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 IRISH CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3611
Mailing Address - Country:US
Mailing Address - Phone:423-626-3345
Mailing Address - Fax:423-626-4341
Practice Address - Street 1:209 IRISH CEMETERY RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3611
Practice Address - Country:US
Practice Address - Phone:423-626-3345
Practice Address - Fax:423-626-4341
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000036051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice