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General NPI Number Information
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NPI Number | 1184145633
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Entity Type | Individual
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Provider Name | AMIT PATEL DDS
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Gender | Male
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 3900 N BAY DR
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City | RACINE
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State | WI
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Zip | 53402-3632
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Country | US
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Telephone | 847-704-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 7971 S 6TH ST APT 217
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City | OAK CREEK
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State | WI
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Zip | 53154-2030
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Country | US
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Telephone | 847-704-2361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 100163115
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License Number State | WI
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