Provider Demographics
NPI:1679625792
Name:PATEL, JANAKKUMAR BHAGUBHAI (DDS)
Entity type:Individual
Prefix:DR
First Name:JANAKKUMAR
Middle Name:BHAGUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANAK
Other - Middle Name:BHAGUBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2440 STATESVILLE BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7128
Mailing Address - Country:US
Mailing Address - Phone:704-216-9153
Mailing Address - Fax:704-216-9155
Practice Address - Street 1:2440 STATESVILLE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-7128
Practice Address - Country:US
Practice Address - Phone:704-216-9153
Practice Address - Fax:704-216-9155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice