Healthcare Provider Details

I. General information

NPI: 1134791601
Provider Name (Legal Business Name): POTTSTOWN FAMILY AND COSMETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HERITAGE DR STE 905
POTTSTOWN PA
19464-9223
US

IV. Provider business mailing address

900 HERITAGE DR STE 905
POTTSTOWN PA
19464-9223
US

V. Phone/Fax

Practice location:
  • Phone: 610-323-9030
  • Fax:
Mailing address:
  • Phone: 610-323-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JYOTI PATEL
Title or Position: PRESIDENT
Credential: DMD
Phone: 610-323-9030