Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7117 | WI |
N | 122300000X | Dentist | DEN4255 | ME |
N | 1223D0001X | Dental Public Health | 7117 | WI |
NPI | 1619237708 |
---|---|
Provider Name | Shaivalkumar S. Patel |
First Address | Marshfield, WI 54449-5703 |
Second Address | Rhinelander, WI 54501-8888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 18/09/2013 |