Healthcare Provider Details

I. General information

NPI: 1194638577
Provider Name (Legal Business Name): KHUSHBOO PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12486 TESSON FERRY RD
SAINT LOUIS MO
63128-2702
US

IV. Provider business mailing address

744 SILVER BUCK LN
CHESTERFIELD MO
63005-3735
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-5533
  • Fax:
Mailing address:
  • Phone: 314-843-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026023627
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: