NPIMap

Organization Active NPI

Manisha Desai Patel

  • General Practice Dentistry
  • Mooresville, NC
National Provider Identifier
1053550145
Registry record updated Feb 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6332 Issued in NC
Legal business name
MANISHA DESAI PATEL
Practice address
224 Talbert Rd
Mooresville, NC 28117-9124
Phone
(704) 799-0552
Fax
(704) 749-8653
NPI assigned
Feb 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Manisha D Patel, DDSNPI 1730191719
Title
Owner
Phone
(704) 799-0552

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 6771 NC
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6332 NC Primary

Addresses

Primary practice location

224 Talbert Rd
Mooresville, NC 28117-9124

Mailing address

224 Talbert Rd
Mooresville, NC 28117-9124
Phone (704) 799-0552

Other identifiers 2

IdentifierTypeStateIssuer
899008CMedicaidNC
899008AMedicaidNC

Other names 1

  • Lake Norman Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Manisha Desai Patel DDS2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

224 Talbert Rd
Mooresville, NC 28117
Phone (704) 799-0552

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1053550145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 TALBERT RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179124",
            "telephone_number": "704-799-0552",
            "fax_number": "704-749-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 TALBERT RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179124",
            "telephone_number": "704-799-0552",
            "fax_number": "704-749-8653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANISHA DESAI PATEL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MANISHA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-799-0552",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "6771",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899008C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899008A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Norman Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.