Provider Demographics
NPI:1982734083
Name:PATEL, ANISH (DMD)
Entity type:Individual
Prefix:DR
First Name:ANISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 INDEPENDENCE POINTE PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3783
Mailing Address - Country:US
Mailing Address - Phone:803-261-0405
Mailing Address - Fax:
Practice Address - Street 1:10550 INDEPENDENCE POINTE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3783
Practice Address - Country:US
Practice Address - Phone:803-261-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics