Healthcare Provider Details

I. General information

NPI: 1548028418
Provider Name (Legal Business Name): PATEL COUNTY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GREENWAY ST NW STE 4
GLEN BURNIE MD
21061-3557
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 207
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8888
  • Fax:
Mailing address:
  • Phone: 845-554-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NIMESH PATEL
Title or Position: OWNER
Credential: DDS
Phone: 845-842-1728