Provider Demographics
NPI:1992900682
Name:PATEL, JINESH S (DMD)
Entity type:Individual
Prefix:DR
First Name:JINESH
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JINESHKUMAR
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4068 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3123
Mailing Address - Country:US
Mailing Address - Phone:252-937-6636
Mailing Address - Fax:252-443-7642
Practice Address - Street 1:4068 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3123
Practice Address - Country:US
Practice Address - Phone:252-937-6636
Practice Address - Fax:252-443-7642
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 71631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice