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General NPI Number Information
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NPI Number | 1750703690
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Entity Type | Organization
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Legal Business Name | DR. SHAKU PATEL, D.D.S.,P.C.
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 209 IRISH CEMETERY RD
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City | TAZEWELL
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State | TN
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Zip | 37879-3611
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Country | US
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Telephone | 423-626-3345
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Fax | 423-626-0560
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Provider Business Mailing Address
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Address Line | 209 IRISH CEMETERY RD
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City | TAZEWELL
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State | TN
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Zip | 37879-3611
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Country | US
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Telephone | 423-626-3345
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Fax | 423-626-0560
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SHAKU J PATEL
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Credential | D.D.S.
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Telephone | 423-626-3345
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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 |
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License Number State |
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