Provider Demographics
NPI:1366595829
Name:PATEL, MITAL (DDS)
Entity type:Individual
Prefix:DR
First Name:MITAL
Middle Name:
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 1:501 W RAY RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7284
Mailing Address - Country:US
Mailing Address - Phone:480-963-0077
Mailing Address - Fax:480-963-4477
Practice Address - Street 1:501 W RAY RD
Practice Address - Street 2:SUITE 10
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7284
Practice Address - Country:US
Practice Address - Phone:480-963-0077
Practice Address - Fax:480-963-4477
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD67021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice