Healthcare Provider Details

I. General information

NPI: 1356276885
Provider Name (Legal Business Name): DEEPA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BISBEE ST
LISBON ME
04250-6835
US

IV. Provider business mailing address

225 INNOVATION WAY UNIT 220
SCARBOROUGH ME
04074-6596
US

V. Phone/Fax

Practice location:
  • Phone: 770-630-8890
  • Fax:
Mailing address:
  • Phone: 770-630-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN5395
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: