Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DRPM1991 | FL |
Y | 1223G0001X | General Practice | DN26008 | FL |
Y | 213EG0000X | General Practice | DN26008 | FL |
N | 1223G0001X | General Practice | DRPM1991 | FL |
N | 213EG0000X | General Practice | DRPM1991 | FL |
N | 124Q00000X | Dental Hygienist | DH24451 | FL |
NPI | 1043745219 |
---|---|
Provider Name | Hardik Patel |
First Address | Merritt Island, FL 32952 |
Second Address | Merritt Island, FL 32952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 22/07/2021 |