=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821568650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKWAY DENTAL NP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2018
-----------------------------------------------------
Last Update Date | 12/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1869 DIXWELL AVE STE 4
-----------------------------------------------------
City | HAMDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06514-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-788-3183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 THORPE STREET EXT
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-4708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-788-3183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NEAL J PATEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 203-788-3183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------