Provider Demographics
NPI:1487131793
Name:PATEL, JIMISKUMAR SATISHKUMAR (DMD)
Entity type:Individual
Prefix:DR
First Name:JIMISKUMAR
Middle Name:SATISHKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W CRESCENT SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-4014
Mailing Address - Country:US
Mailing Address - Phone:336-570-3882
Mailing Address - Fax:336-570-3583
Practice Address - Street 1:150 W CRESCENT SQUARE DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-4014
Practice Address - Country:US
Practice Address - Phone:336-570-3882
Practice Address - Fax:336-570-3583
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9226122300000X
NC12612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist