MEDICARE: SWEET TOOTH FAMILY DENTISTRY PC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1770127300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET TOOTH FAMILY DENTISTRY PC

Provider Business Mailing Address
First Line	:	2181 EMANUEL CT
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5677
Country	:	US
Telephone Number	:	310-488-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	488 CONCHESTER HWY
Second Line	:
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19014-3129
Country	:	US
Telephone Number	:	610-485-2600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ZALAK PATEL
Credential	:	DDS
Telephone Number	:	310-488-1973

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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