Provider Demographics
NPI:1336417526
Name:PATEL, ASHISH G (MSD DDS)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MSD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20039 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2322
Mailing Address - Country:US
Mailing Address - Phone:248-259-8303
Mailing Address - Fax:
Practice Address - Street 1:20039 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2322
Practice Address - Country:US
Practice Address - Phone:248-259-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist