Provider Demographics
NPI:1841680741
Name:PATEL, AMIE
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 S RIVERSIDE DR
Mailing Address - Street 2:APT 1024
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6511
Mailing Address - Country:US
Mailing Address - Phone:478-396-6993
Mailing Address - Fax:
Practice Address - Street 1:9425 S RIVERSIDE DR
Practice Address - Street 2:APT 1024
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070
Practice Address - Country:US
Practice Address - Phone:478-396-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA100318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program