Healthcare Provider Details

I. General information

NPI: 1639829476
Provider Name (Legal Business Name): PRIYA P PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/24/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SOUTH BROAD STREET SUITE #19
MERIDEN CT
06450
US

IV. Provider business mailing address

490 SOUTH BROAD STREET SUITE 19
MERIDEN CT
06450
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-1000
  • Fax:
Mailing address:
  • Phone: 203-237-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13805
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: