Healthcare Provider Details

I. General information

NPI: 1831593599
Provider Name (Legal Business Name): KUSHAN PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N SALEM ST STE 105
APEX NC
27502-2315
US

IV. Provider business mailing address

2015 VALLEYGATE DR
FAYETTEVILLE NC
28304-3757
US

V. Phone/Fax

Practice location:
  • Phone: 919-804-0351
  • Fax:
Mailing address:
  • Phone: 910-485-7070
  • Fax: 910-485-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: