Provider Demographics
NPI:1457159592
Name:MISSOURI GARDENS DENTAL
Entity type:Organization
Organization Name:MISSOURI GARDENS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-461-4832
Mailing Address - Street 1:15 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4830
Mailing Address - Country:US
Mailing Address - Phone:727-461-4832
Mailing Address - Fax:
Practice Address - Street 1:15 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4830
Practice Address - Country:US
Practice Address - Phone:727-461-4832
Practice Address - Fax:727-461-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental