Healthcare Provider Details

I. General information

NPI: 1760035505
Provider Name (Legal Business Name): TEJAL PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 IOWA AVE W STE 102
MARSHALLTOWN IA
50158-2985
US

IV. Provider business mailing address

1200 UNIVERSITY AVE STE 200
DES MOINES IA
50314-2355
US

V. Phone/Fax

Practice location:
  • Phone: 641-753-4021
  • Fax: 515-644-6792
Mailing address:
  • Phone: 515-248-1447
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10448
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: