MEDICARE: DR. SMITA PATEL DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE00010731	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE00010731	OTHER	WA	STATE LICENSE

General Provider Information

NPI Number	:	1467668608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SMITA PATEL DMD, MS

Provider Business Mailing Address
First Line	:	1908 201ST PL SE APT 201
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98012-8572
Country	:	US
Telephone Number	:	206-658-3329
Fax Number	:	425-491-7233

Provider Business Practice Location Address
First Line	:	1908 201ST PL SE APT 201
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98012-8572
Country	:	US
Telephone Number	:	206-658-3329
Fax Number	:	425-491-7233

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	11/08/2024

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