MEDICARE: JAYANTILAL L. PATEL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS020874L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033117676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYANTILAL L. PATEL D.D.S.

Provider Business Mailing Address
First Line	:	767 5TH AVE
Second Line	:	SUITE B-3A
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-4207
Country	:	US
Telephone Number	:	717-263-4462
Fax Number	:	717-263-8014

Provider Business Practice Location Address
First Line	:	767 5TH AVE
Second Line	:	SUITE B-3A
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-4207
Country	:	US
Telephone Number	:	717-263-4462
Fax Number	:	717-263-8014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/10/2011

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