Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN23297 | FL |
N | 1223P0221X | Pediatric Dentist | DN23297 | FL |
NPI | 1003260910 |
---|---|
Provider Name | Mrs. Khusbu Pravin Patel |
First Address | Tampa, FL 33612 |
Second Address | Tampa, FL 33615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2016 |
Last Update Date | 13/12/2019 |