Provider Demographics
NPI:1649630492
Name:PATEL, SAMIR DILIP (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:DILIP
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 HIGHWAY 160 W STE 104
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8487
Mailing Address - Country:US
Mailing Address - Phone:803-650-3712
Mailing Address - Fax:
Practice Address - Street 1:2526 HIGHWAY 160 W STE 104
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8487
Practice Address - Country:US
Practice Address - Phone:803-650-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103371223P0300X
SC82291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8229OtherDENTAL LICENSE
NC10337OtherDENTAL LICENSE