Provider Demographics
NPI:1770934440
Name:PATEL, PRATIK SURESHBHAI (DDS)
Entity type:Individual
Prefix:
First Name:PRATIK
Middle Name:SURESHBHAI
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 1:153 WEIGANDS LN
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2128
Mailing Address - Country:US
Mailing Address - Phone:646-407-6663
Mailing Address - Fax:
Practice Address - Street 1:1030 FREELAND DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5175
Practice Address - Country:US
Practice Address - Phone:855-894-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice