Healthcare Provider Details

I. General information

NPI: 1467569152
Provider Name (Legal Business Name): AMUL G PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SOUTH 1ST AVENUE
MT VERNON NY
10550
US

IV. Provider business mailing address

22 SOUTH 1ST AVENUE
MT VERNON NY
10550
US

V. Phone/Fax

Practice location:
  • Phone: 914-668-3341
  • Fax: 914-668-1176
Mailing address:
  • Phone: 914-668-3341
  • Fax: 914-668-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044262
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number010454
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: