Healthcare Provider Details

I. General information

NPI: 1831644806
Provider Name (Legal Business Name): SHRADDHA G PATEL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 HAMILTON BLVD UNIT 210
TREXLERTOWN PA
18087-9103
US

IV. Provider business mailing address

257 REDCLOVER LN
ALLENTOWN PA
18104-9240
US

V. Phone/Fax

Practice location:
  • Phone: 610-914-1700
  • Fax: 484-466-3839
Mailing address:
  • Phone: 732-983-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32324
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041621
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: