Provider Demographics
NPI:1881917540
Name:PATEL, VIRAL M (DMD)
Entity type:Individual
Prefix:
First Name:VIRAL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 103RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6711
Mailing Address - Country:US
Mailing Address - Phone:904-778-0366
Mailing Address - Fax:904-778-0003
Practice Address - Street 1:7408 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-778-0366
Practice Address - Fax:904-778-0003
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0025479-00Medicaid