Provider Demographics
NPI:1841815362
Name:PATEL, PAYALBEN BALDEV (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:PAYALBEN
Middle Name:BALDEV
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 FONTANELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6846
Mailing Address - Country:US
Mailing Address - Phone:769-234-0615
Mailing Address - Fax:
Practice Address - Street 1:117 FONTANELLE BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6846
Practice Address - Country:US
Practice Address - Phone:769-234-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist