Healthcare Provider Details

I. General information

NPI: 1063113074
Provider Name (Legal Business Name): DEEPKUMAR PATEL DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 REFORMATORY RD
PENDLETON IN
46064-8767
US

IV. Provider business mailing address

4819 MORNING VALLEY CT
MCCORDSVILLE IN
46055-0229
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-8011
  • Fax:
Mailing address:
  • Phone: 479-979-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014536A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: