=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144108200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BANSARI PATEL DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 591 CRANBURY RD STE 101
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-4094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-390-7645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 REBECCA CT
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08810-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-239-3054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI03117900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------