Provider Demographics
NPI:1982694865
Name:PATEL, MANILAL I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANILAL
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4498
Mailing Address - Country:US
Mailing Address - Phone:631-231-5566
Mailing Address - Fax:516-750-1450
Practice Address - Street 1:566 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4210
Practice Address - Country:US
Practice Address - Phone:631-231-5566
Practice Address - Fax:631-231-0561
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00336383Medicaid