Healthcare Provider Details

I. General information

NPI: 1861689507
Provider Name (Legal Business Name): MANISHA DESAI PATEL DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MULBERRY ST SW
LENOIR NC
28645-5721
US

IV. Provider business mailing address

310 MULBERRY ST SW
LENOIR NC
28645
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-7881
  • Fax: 828-754-5391
Mailing address:
  • Phone: 828-754-7881
  • Fax: 828-754-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6771
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6332
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8154
License Number StateNC

VIII. Authorized Official

Name: PARESH B PATEL
Title or Position: OWNER
Credential: DDS
Phone: 828-754-7881