=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710468194
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KESHAV ASHWIN PATEL DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2018
-----------------------------------------------------
Last Update Date | 08/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 327 TOWNSHIP LINE RD
-----------------------------------------------------
City | ELKINS PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19027-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-409-2583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 WINFIELD CT
-----------------------------------------------------
City | FAIRLESS HILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19030-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-598-0921
-----------------------------------------------------
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 | DS041935
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------