Provider Demographics
NPI:1215423322
Name:PATEL, KETAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KETAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-1716
Mailing Address - Country:US
Mailing Address - Phone:757-237-5450
Mailing Address - Fax:
Practice Address - Street 1:176 THOMAS JOHNSON DR STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4532
Practice Address - Country:US
Practice Address - Phone:301-264-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014161461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD18442OtherDENTAL LICENSE
VA0401416146OtherDENTAL LICENSE