Healthcare Provider Details

I. General information

NPI: 1386060366
Provider Name (Legal Business Name): NEAL PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E MARION ST STE 200
SHELBY NC
28150-0001
US

IV. Provider business mailing address

1610 E MARION ST STE 200
SHELBY NC
28150-0001
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-8934
  • Fax:
Mailing address:
  • Phone: 704-482-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: