Healthcare Provider Details

I. General information

NPI: 1336989151
Provider Name (Legal Business Name): KISHAN V PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 RITTENHOUSE PL
ARDMORE PA
19003-2241
US

IV. Provider business mailing address

3020 TWIN LAKES DR
MATTHEWS NC
28104-6114
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-7670
  • Fax:
Mailing address:
  • Phone: 704-806-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD10853
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14027
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045615
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: