Healthcare Provider Details

I. General information

NPI: 1962995605
Provider Name (Legal Business Name): TRISHA RAJESH PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MORRISON DR
CLINTON MS
39056-5239
US

IV. Provider business mailing address

100 SUMMER LAKE CV
RIDGELAND MS
39157-8632
US

V. Phone/Fax

Practice location:
  • Phone: 601-925-5163
  • Fax:
Mailing address:
  • Phone: 601-540-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4000-18
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: