=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780712638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALPA J PATEL DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 10/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 COURT ST SUITE #270
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03766-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-448-1830
-----------------------------------------------------
Fax | 603-448-1826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 COURT ST SUITE #270
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03766-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-448-1830
-----------------------------------------------------
Fax | 603-448-1826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 03781
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------