Healthcare Provider Details

I. General information

NPI: 1790343655
Provider Name (Legal Business Name): NEEL SURESH VAKHARIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 KUSER RD
TRENTON NJ
08619-3830
US

IV. Provider business mailing address

16 GLENDALE LN
FAIRFIELD NJ
07004-1919
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-1616
  • Fax:
Mailing address:
  • Phone: 973-882-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number059388-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02754600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: