Provider Demographics
NPI:1881919926
Name:PATEL, MANOJ K (DDS)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 WILSHIRE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3282
Mailing Address - Country:US
Mailing Address - Phone:407-291-7220
Mailing Address - Fax:407-291-7221
Practice Address - Street 1:2869 WILSHIRE DR STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3282
Practice Address - Country:US
Practice Address - Phone:407-291-7220
Practice Address - Fax:407-291-7221
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-189821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice