=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811888373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUSHAR PATEL DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7215 PASSYUNK AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19142-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 121-522-0646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1615 N 2ND ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19122-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-630-7193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TUSHAR PATEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 608-630-7193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------