=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811711526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUDERTON DENTAL COSMETIC CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2024
-----------------------------------------------------
Last Update Date | 02/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 N MAIN ST
-----------------------------------------------------
City | SOUDERTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18964-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-723-3674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 N MAIN ST
-----------------------------------------------------
City | SOUDERTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18964-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-723-3674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAY PATEL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 973-452-3190
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------