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General NPI Number Information
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NPI Number | 1295249456
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Entity Type | Organization
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Legal Business Name | PA DENTAL LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 17 MAIN ST STE 301
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City | ROBBINSVILLE
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State | NJ
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Zip | 08691-1401
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Country | US
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Telephone | 732-213-0036
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EXECUTIVE DR STE 103
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City | MONMOUTH JUNCTION
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State | NJ
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Zip | 08852-2446
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Country | US
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Telephone | 732-422-8668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICKEN PATEL
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Credential | DMD
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Telephone | 732-213-0036
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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