Provider Demographics
NPI:1730224759
Name:PATEL, MUKESH C (DDS)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:C
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 1:107 W HINDS AVE
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1116
Mailing Address - Country:US
Mailing Address - Phone:315-363-2733
Mailing Address - Fax:315-363-2733
Practice Address - Street 1:107 W HINDS AVE
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1116
Practice Address - Country:US
Practice Address - Phone:315-363-2733
Practice Address - Fax:315-363-2733
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032737-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00558810Medicaid