Healthcare Provider Details

I. General information

NPI: 1790040749
Provider Name (Legal Business Name): SEENA PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10214 N TATUM BLVD STE A1100
PHOENIX AZ
85028-4243
US

IV. Provider business mailing address

10214 N TATUM BLVD STE A100
PHOENIX AZ
85028-4231
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-1486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008096
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License NumberD008096
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD008096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: