Provider Demographics
NPI:1871140848
Name:PATEL, KISHEN
Entity type:Individual
Prefix:
First Name:KISHEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E JEFFERSON AVE APT 610
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2657
Mailing Address - Country:US
Mailing Address - Phone:678-975-8169
Mailing Address - Fax:
Practice Address - Street 1:5425 FRUITVILLE RD STE 16
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6418
Practice Address - Country:US
Practice Address - Phone:941-343-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist