Provider Demographics
NPI:1255418174
Name:PATEL, HIREN
Entity type:Individual
Prefix:DR
First Name:HIREN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 E ROUGH RIDER RD
Mailing Address - Street 2:#1024
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7346
Mailing Address - Country:US
Mailing Address - Phone:804-536-5169
Mailing Address - Fax:
Practice Address - Street 1:8085 W BELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3825
Practice Address - Country:US
Practice Address - Phone:623-486-5430
Practice Address - Fax:623-878-6467
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115561223G0001X
AZ80851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ548413OtherAHCCCS
VA9183735Medicaid