Provider Demographics
NPI:1730191719
Name:PATEL, MANISHA D (DDS)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TALBERT RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9124
Mailing Address - Country:US
Mailing Address - Phone:704-799-0552
Mailing Address - Fax:828-754-5391
Practice Address - Street 1:224 TALBERT RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9124
Practice Address - Country:US
Practice Address - Phone:704-799-0552
Practice Address - Fax:828-754-5391
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899008CMedicaid