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General NPI Number Information
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NPI Number | 1588350417
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Entity Type | Individual
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Provider Name | VISHAL PATEL DMD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 110 BERGEN ST LEVEL B, RSDM DENTAL SCHOOL ORAL SURGERY CLINIC
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City | NEWARK
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State | NJ
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Zip | 07103-2495
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Country | US
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Telephone | 973-972-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 1236 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-3149
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Country | US
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Telephone |
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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 | 22DI03008500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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