Healthcare Provider Details

I. General information

NPI: 1407007941
Provider Name (Legal Business Name): AMITA R PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH RD UPPER MERION DENTAL ASSOCIATES
KING OF PRUSSIA PA
19406-3174
US

IV. Provider business mailing address

357 S GULPH RD SUITE 100
KING OF PRUSSIA PA
19406-3136
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-2325
  • Fax:
Mailing address:
  • Phone: 610-337-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS037145
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: