Healthcare Provider Details

I. General information

NPI: 1710661244
Provider Name (Legal Business Name): RAJ BHAVESH PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 S 27TH ST
FRANKLIN WI
53132-8045
US

IV. Provider business mailing address

6855 S 27TH ST
FRANKLIN WI
53132-8045
US

V. Phone/Fax

Practice location:
  • Phone: 414-435-0787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number600126515
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: