Healthcare Provider Details

I. General information

NPI: 1184716490
Provider Name (Legal Business Name): JEETENDRA PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 STERLINGTON RD
MONROE LA
71203-2522
US

IV. Provider business mailing address

1421 TOULOUSE DR
MONROE LA
71201-3661
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2922
  • Fax:
Mailing address:
  • Phone: 318-348-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5451
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: