Provider Demographics
NPI:1881917540
Name:PATEL, VIRAL M (DMD)
Entity type:Individual
Prefix:
First Name:VIRAL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HUNTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3063
Mailing Address - Country:US
Mailing Address - Phone:904-735-4803
Mailing Address - Fax:
Practice Address - Street 1:7645 GATE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2890
Practice Address - Country:US
Practice Address - Phone:904-998-9820
Practice Address - Fax:904-998-6650
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0025479-00Medicaid