Provider Demographics
NPI:1780995043
Name:PATEL, HETAL SUJAL (DDS)
Entity type:Individual
Prefix:DR
First Name:HETAL
Middle Name:SUJAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44757 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1071
Mailing Address - Country:US
Mailing Address - Phone:248-668-9419
Mailing Address - Fax:
Practice Address - Street 1:2200 N CANTON CENTER RD STE 100A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5037
Practice Address - Country:US
Practice Address - Phone:734-981-8040
Practice Address - Fax:734-981-6432
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202571223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice