MEDICARE: DISHA PATEL

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	701-33645	FL

General Provider Information

NPI Number	:	1699605097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DISHA PATEL

Provider Business Mailing Address
First Line	:	4969 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3657
Country	:	US
Telephone Number	:	863-614-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	4969 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3657
Country	:	US
Telephone Number	:	863-614-0044
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ DISHA PATEL ” Practice Location

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