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General NPI Number Information
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NPI Number | 1063792927
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Entity Type | Organization
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Legal Business Name | SANDEEP V. PATEL, DDS, PA
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 201 W. ISB
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-258-7500
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Fax | 386-238-5388
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Provider Business Mailing Address
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Address Line | 201 W. ISB
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-258-7500
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Fax | 386-238-5388
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Authorized Official
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Title or Position | CORP OFFICER
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Name | SANDEEP V PATEL
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Credential | D.D.S.
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Telephone | 305-494-5002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN19247
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License Number State | FL
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