Healthcare Provider Details

I. General information

NPI: 1235118829
Provider Name (Legal Business Name): AJIT R PATEL DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 WILLIAMSTOWN RD
SICKLERVILLE NJ
08081
US

IV. Provider business mailing address

529 WILLIAMSTOWN RD
SICKLERVILLE NJ
08081
US

V. Phone/Fax

Practice location:
  • Phone: 856-728-7775
  • Fax: 856-728-1107
Mailing address:
  • Phone: 856-728-7775
  • Fax: 856-728-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI17076
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: