Healthcare Provider Details

I. General information

NPI: 1851221055
Provider Name (Legal Business Name): VRAJ PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 39TH AVE STE 1
PLEASANT PRAIRIE WI
53158-3733
US

IV. Provider business mailing address

301 N 17TH AVE STE 200
WAUSAU WI
54401-4750
US

V. Phone/Fax

Practice location:
  • Phone: 262-360-6371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002142-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: