Provider Demographics
NPI:1912493057
Name:PATEL, ADITI AMIT (DMD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:AMIT
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6152 LAKE WALDON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2293
Mailing Address - Country:US
Mailing Address - Phone:248-892-8007
Mailing Address - Fax:
Practice Address - Street 1:2685 TITTABAWASSEE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-8217
Practice Address - Country:US
Practice Address - Phone:989-755-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0417921223G0001X
MI29010229481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice