Healthcare Provider Details

I. General information

NPI: 1245715408
Provider Name (Legal Business Name): MAULIKKUMAR N PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8956 J M KEYNES DR STE 500
CHARLOTTE NC
28262-8626
US

IV. Provider business mailing address

8956 J M KEYNES DR STE 500
CHARLOTTE NC
28262-8626
US

V. Phone/Fax

Practice location:
  • Phone: 980-890-7590
  • Fax: 980-895-4454
Mailing address:
  • Phone: 980-890-7590
  • Fax: 980-895-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14682
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: