Healthcare Provider Details

I. General information

NPI: 1548619042
Provider Name (Legal Business Name): MRS. CHANDANI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHANDANI PATEL D.D.S

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N KELLY AVE
EDMOND OK
73003-3233
US

IV. Provider business mailing address

9609 LAKECREST DR
OKLAHOMA CITY OK
73159-6775
US

V. Phone/Fax

Practice location:
  • Phone: 405-330-5095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6798
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: