Healthcare Provider Details

I. General information

NPI: 1134836596
Provider Name (Legal Business Name): PATEL & ASSOCIATES 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W CRESCENT SQUARE DR
GRAHAM NC
27253-4014
US

IV. Provider business mailing address

150 W CRESCENT SQUARE DR
GRAHAM NC
27253-4014
US

V. Phone/Fax

Practice location:
  • Phone: 336-570-3882
  • Fax: 336-570-3583
Mailing address:
  • Phone: 336-570-3882
  • Fax: 336-570-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JIMISKUMAR S PATEL
Title or Position: MANAGER
Credential: DMD
Phone: 336-570-3882