MEDICARE: DR. MITAL PATEL DDS

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	D6702	AZ

General Provider Information

NPI Number	:	1366595829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITAL PATEL DDS

Provider Business Mailing Address
First Line	:	501 W RAY RD
Second Line	:	SUITE 10
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7284
Country	:	US
Telephone Number	:	480-963-0077
Fax Number	:	480-963-4477

Provider Business Practice Location Address
First Line	:	501 W RAY RD
Second Line	:	SUITE 10
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7284
Country	:	US
Telephone Number	:	480-963-0077
Fax Number	:	480-963-4477

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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