1336555903 NPI number — BRIJESH M PATEL DDS, LLC

Table of content: (NPI 1336555903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336555903 NPI number — BRIJESH M PATEL DDS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIJESH M PATEL DDS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336555903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
982 GALLOWAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLOWAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43119-8293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-824-5671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
982 GALLOWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43119-8293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-824-5671
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
BRIJESH
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-824-5671

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  30.021769 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30.021769 . This is a "STATE OF OHIO DENTAL BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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