Healthcare Provider Details

I. General information

NPI: 1275862831
Provider Name (Legal Business Name): NEHA JIVAN PATEL DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E CHOCOLATE AVE
HERSHEY PA
17033
US

IV. Provider business mailing address

3825 LINGLESTOWN RD
HARRISBURG PA
17110
US

V. Phone/Fax

Practice location:
  • Phone: 717-652-4033
  • Fax: 717-533-5323
Mailing address:
  • Phone: 717-652-3887
  • Fax: 717-652-9059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDSO36426
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: