Basic Information
| Provider Information | |||||||||
| NPI: | 1871955724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SAGIR | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1839 WAGON WHEEL CIR E | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323177439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502842372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17365 US HIGHWAY 441 | ||||||||
| Address2: | |||||||||
| City: | MOUNT DORA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522703015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN21855 | FL | Y | Dental Providers | Dentist | General Practice |
No ID Information.