Healthcare Provider Details

I. General information

NPI: 1124952395
Provider Name (Legal Business Name): TBP DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 OLD COUNTRY ROAD
DIX HILLS NY
11746
US

IV. Provider business mailing address

6 LAUREL LN
OLD WESTBURY NY
11568-1544
US

V. Phone/Fax

Practice location:
  • Phone: 631-629-1680
  • Fax:
Mailing address:
  • Phone: 516-581-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TEJAS PATEL
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 516-581-3605