=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053569087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMILTON DENTAL ASSOCIATES OF LEHIGH VALLEY,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2008
-----------------------------------------------------
Last Update Date | 09/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1144 HAMILTON ST
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18101-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-435-2550
-----------------------------------------------------
Fax | 610-351-7451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1144 HAMILTON ST
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18101-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-435-2550
-----------------------------------------------------
Fax | 610-351-7451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. SMITA C. PATEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 610-435-2550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS029262L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------