Healthcare Provider Details

I. General information

NPI: 1760652861
Provider Name (Legal Business Name): RUSHI S PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD ROOM D7-6
GAINESVILLE FL
32610-0416
US

IV. Provider business mailing address

2508 SW 35TH PL # U-121
GAINESVILLE FL
32608-3252
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6750
  • Fax: 352-392-7609
Mailing address:
  • Phone: 816-547-8744
  • Fax: 352-637-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17708
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN-17708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: