MEDICARE: POOJA J PATEL DDS

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	390200000X	Student in an Organized Health Care Education/Training Program	14385	CT
2	1223G0001X	General Practice Dentistry	DN10001253	MA

General Provider Information

NPI Number	:	1629863030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POOJA J PATEL DDS

Provider Business Mailing Address
First Line	:	42 REPUBLIC DR APT 134
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-5462
Country	:	US
Telephone Number	:	847-764-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 BROAD ST
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-2912
Country	:	US
Telephone Number	:	413-998-0698
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/22/2026

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Directions to “ POOJA J PATEL DDS” Practice Location

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