Healthcare Provider Details

I. General information

NPI: 1972420651
Provider Name (Legal Business Name): K R PATEL DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16550 SUNRISE LAKE BLVD
CLERMONT FL
37414
US

IV. Provider business mailing address

16550 SUNRISE LAKE BLVD
CLERMONT FL
37414
US

V. Phone/Fax

Practice location:
  • Phone: 678-633-9944
  • Fax:
Mailing address:
  • Phone: 678-633-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEYURKUMAR PATEL
Title or Position: OWNER
Credential:
Phone: 678-633-9944