Healthcare Provider Details

I. General information

NPI: 1396425997
Provider Name (Legal Business Name): MR. RUTVIK PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5139 W. SAGINAW HWY,
LANSING MI
48917
US

IV. Provider business mailing address

5139 W. SAGINAW HWY,
LANSING MI
48917
US

V. Phone/Fax

Practice location:
  • Phone: 551-388-3409
  • Fax:
Mailing address:
  • Phone: 551-388-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: