Healthcare Provider Details

I. General information

NPI: 1841663309
Provider Name (Legal Business Name): VISHAL PRAFUL PATEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALLEY RD
WAYNE NJ
07470-3535
US

IV. Provider business mailing address

60 RIDGE DR
MONTVILLE NJ
07045-9168
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-5440
  • Fax: 973-633-1903
Mailing address:
  • Phone: 973-830-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02635200
License Number StateNJ
# 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: