Provider Demographics
NPI:1982088126
Name:PATEL, KHUSHBU N
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:N
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 1:2405 SHUDA AVE
Mailing Address - Street 2:APT D
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1392
Mailing Address - Country:US
Mailing Address - Phone:205-356-3567
Mailing Address - Fax:
Practice Address - Street 1:2924 E FRANKLIN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-9448
Practice Address - Country:US
Practice Address - Phone:855-644-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0405331223G0001X
NC102521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice