MEDICARE: BHOOMIBEN 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	122300000X	Dentist	13758	NC

General Provider Information

NPI Number	:	1861239493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHOOMIBEN PATEL DDS

Provider Business Mailing Address
First Line	:	9918 BRAWLEY LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5004
Country	:	US
Telephone Number	:	301-917-4499
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 UNIVERSITY EXEC PARK DR STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3357
Country	:	US
Telephone Number	:	704-547-1279
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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