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General NPI Number Information
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NPI Number | 1164734752
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Entity Type | Individual
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Provider Name | LISA PATEL D.D.S
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Gender | Female
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 28160 OLD VILLAGE RD
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City | MECHANICSVILLE
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State | MD
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Zip | 20659-4289
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Country | US
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Telephone | 301-884-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 723 WINTON AVE
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City | GLEN BURNIE
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State | MD
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Zip | 21061-2479
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Country | US
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Telephone | 410-761-5615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14570
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License Number State | MD
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