MEDICARE: DR. CHANDNI KANTI PATEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901600170	MI

General Provider Information

NPI Number	:	1144882119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDNI KANTI PATEL DDS

Provider Business Mailing Address
First Line	:	35253 VALLEY FORGE DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-4619
Country	:	US
Telephone Number	:	248-508-6673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 DIVISION AVE S
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3029
Country	:	US
Telephone Number	:	616-229-0049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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