MEDICARE: ELE-DENT PEDIATRIC DENTISTRY, LLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1639771058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELE-DENT PEDIATRIC DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	265 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-3127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-3127
Country	:	US
Telephone Number	:	609-799-7722
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MILAN M PATEL
Credential	:	DMD
Telephone Number	:	609-799-7722

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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