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General NPI Number Information
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NPI Number | 1265883573
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Entity Type | Individual
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Provider Name | SAGAR PATEL DDS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD DIVISION OF DENTISTRY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 734-215-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 240 S 40TH ST DEPARTMENT OF PEDIATRIC DENTISTRY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-6030
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Country | US
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Telephone | 734-215-7505
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | NOTIFICATION OF POST
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS040774
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License Number State | PA
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