MEDICARE: DR. MONA PATEL

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	122300000X	Dentist	019.033336	IL
2	122300000X	Dentist	2024003609	MO

General Provider Information

NPI Number	:	1639742562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA PATEL

Provider Business Mailing Address
First Line	:	1810 PARTRIDGE PL
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-5512
Country	:	US
Telephone Number	:	334-201-0659
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 N 10TH ST STE A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-2062
Country	:	US
Telephone Number	:	314-231-6151
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	02/13/2024

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Directions to “ DR. MONA PATEL ” Practice Location

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