Healthcare Provider Details

I. General information

NPI: 1053401638
Provider Name (Legal Business Name): MEENAKSHI PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 N CEDAR ST APT A
ELKO NV
89801-2991
US

IV. Provider business mailing address

674 N CEDAR ST APT A
ELKO NV
89801-2991
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-3737
  • Fax: 775-777-3738
Mailing address:
  • Phone: 775-777-3737
  • Fax: 775-777-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4646
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4646T
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: