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General NPI Number Information
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NPI Number | 1790804920
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Entity Type | Organization
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Legal Business Name | SAMIR PATEL DDS ,LLC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 332 BELLEVILLE AVE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3652
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Country | US
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Telephone | 973-743-1755
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Fax | 973-743-6199
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Provider Business Mailing Address
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Address Line | 332 BELLEVILLE AVE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3652
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Country | US
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Telephone | 973-743-1755
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Fax | 973-743-6199
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SAMIR P PATEL
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Credential | D.D.S.
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Telephone | 973-743-1755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20649
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License Number State | NJ
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