Healthcare Provider Details

I. General information

NPI: 1508533654
Provider Name (Legal Business Name): ANJALI PATEL BRAHMBHATT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 GOODMAN RD W
HORN LAKE MS
38637-1303
US

IV. Provider business mailing address

945 LOWER BRIDGE DR APT 8
FAYETTEVILLE NC
28303-0842
US

V. Phone/Fax

Practice location:
  • Phone: 662-393-9200
  • Fax: 662-393-9895
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4323-22
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: