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General NPI Number Information
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NPI Number | 1811535578
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Entity Type | Individual
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Provider Name | KRISHNA KARDAM PATEL DMD
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Gender | Female
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 1476 POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-5937
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Country | US
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Telephone | 203-292-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 131 ALFRED ST
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City | EDISON
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State | NJ
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Zip | 08820-3801
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Country | US
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Telephone | 732-829-0771
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13217
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License Number State | CT
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