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General NPI Number Information
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NPI Number | 1902117203
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Entity Type | Individual
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Provider Name | KOMAL S PATEL DDS
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Gender | Female
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 28345 BECK RD #409
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City | WIXOM
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State | MI
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Zip | 48393-4733
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Country | US
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Telephone | 888-477-7325
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Fax |
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Provider Business Mailing Address
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Address Line | 2281 LAKE RIDGE DR
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City | GRAND BLANC
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State | MI
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Zip | 48439-7365
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Country | US
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Telephone | 919-306-2870
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021723
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 055639
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DI02502600
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License Number State | NJ
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