Healthcare Provider Details

I. General information

NPI: 1720914153
Provider Name (Legal Business Name): DEEP PIYUSHKUMAR PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 E SUNRISE DR
TUCSON AZ
85718
US

IV. Provider business mailing address

20000 N 57TH AVE RM H308
GLENDALE AZ
85308-6878
US

V. Phone/Fax

Practice location:
  • Phone: 520-526-1343
  • Fax:
Mailing address:
  • Phone: 409-354-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012827
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: