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General NPI Number Information
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NPI Number | 1760842652
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Entity Type | Individual
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Provider Name | SRUJALKUMAR PATEL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 2501 W PIERSON RD DENTAL DREAMS
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City | FLINT
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State | MI
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Zip | 48504-6802
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Country | US
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Telephone | 310-890-9334
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 W PIERSON ROAD DENTAL DREAMS
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City | FLINT
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State | MI
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Zip | 48504
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020843
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License Number State | MI
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