Provider Demographics
NPI:1174803480
Name:PATEL, JAINISHA R (DDS)
Entity type:Individual
Prefix:DR
First Name:JAINISHA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N JOSEY LN STE 306
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3000
Mailing Address - Country:US
Mailing Address - Phone:989-858-6964
Mailing Address - Fax:
Practice Address - Street 1:2150 N JOSEY LN STE 306
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3000
Practice Address - Country:US
Practice Address - Phone:989-858-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0106081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice