Healthcare Provider Details

I. General information

NPI: 1235526328
Provider Name (Legal Business Name): RYAN PATEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 N ARMENIA AVE STE 200
TAMPA FL
33603-2603
US

IV. Provider business mailing address

4714 N ARMENIA AVE STE 200
TAMPA FL
33603-2603
US

V. Phone/Fax

Practice location:
  • Phone: 813-885-6555
  • Fax: 813-442-4691
Mailing address:
  • Phone: 813-885-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401416441
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN24050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: