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General NPI Number Information
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NPI Number | 1790426369
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Entity Type | Individual
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Provider Name | ITISHA PATEL DDS
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 4620 RIDGE RD
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City | BROOKLYN
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State | OH
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Zip | 44128-2173
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Country | US
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Telephone | 216-661-8077
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Fax |
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Provider Business Mailing Address
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Address Line | 11098 RICHLAND DR
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City | NORTH ROYALTON
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State | OH
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Zip | 44133-2789
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Country | US
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Telephone | 440-212-2612
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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 | 30.027729
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License Number State | OH
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