MEDICARE: DR. SONAL PATEL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS042297	PA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336639509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONAL PATEL DMD

Provider Business Mailing Address
First Line	:	2119 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-663-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-663-5472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	08/05/2020

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