Provider Demographics
NPI:1770360042
Name:PATEL, BHAVINKUMAR BALENDRAKUMAR (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:BHAVINKUMAR
Middle Name:BALENDRAKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7826 CORNERS COVE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:440-231-8738
Mailing Address - Fax:
Practice Address - Street 1:1032 FAIRPLAIN DR
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-5799
Practice Address - Country:US
Practice Address - Phone:269-332-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty