Provider Demographics
NPI:1134533441
Name:PATEL, ASHA (DMD)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N. LEMANS BLVD UNIT 1113
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:561-542-1898
Mailing Address - Fax:
Practice Address - Street 1:1514 N FLORIDA AVE
Practice Address - Street 2:STE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2602
Practice Address - Country:US
Practice Address - Phone:813-490-1957
Practice Address - Fax:813-409-1958
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 203161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice