Provider Demographics
NPI:1265773675
Name:PATEL, RUSHI JAYANTI (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSHI
Middle Name:JAYANTI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 GEORGETOWN CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1526
Mailing Address - Country:US
Mailing Address - Phone:410-531-0343
Mailing Address - Fax:
Practice Address - Street 1:680 INDEPENDENCE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8015
Practice Address - Country:US
Practice Address - Phone:972-535-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0578831223G0001X
TX33552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice