Healthcare Provider Details

I. General information

NPI: 1255798781
Provider Name (Legal Business Name): HETAL PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 ROUTE 33
HAMILTON NJ
08619
US

IV. Provider business mailing address

405 ARNOLD DR
FLORENCE NJ
08518-4005
US

V. Phone/Fax

Practice location:
  • Phone: 609-228-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDI02677800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: