MEDICARE: DEEP DEVENDRABHAI PATEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12014765A	IN

General Provider Information

NPI Number	:	1386538486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEP DEVENDRABHAI PATEL DDS

Provider Business Mailing Address
First Line	:	7621 ALLENWOOD CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4738
Country	:	US
Telephone Number	:	317-666-0893
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8010
Country	:	US
Telephone Number	:	812-608-4458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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