Provider Demographics
NPI:1316115140
Name:DR SA PATEL PA
Entity type:Organization
Organization Name:DR SA PATEL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:S.A.
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-423-5411
Mailing Address - Street 1:231 W MAIN STREET
Mailing Address - Street 2:PO BOX 317
Mailing Address - City:COTTONWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56229-0318
Mailing Address - Country:US
Mailing Address - Phone:507-423-5411
Mailing Address - Fax:
Practice Address - Street 1:231 W MAIN ST.
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:MN
Practice Address - Zip Code:56229-0318
Practice Address - Country:US
Practice Address - Phone:507-423-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S. A. PATEL D.D.S., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8395261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental