MEDICARE: DR. SEENA PATEL DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D8096	AZ
2	122300000X	Dentist	D8096	AZ
3	125Q00000X	Oral Medicine Dentistry	D8096	AZ
4	1223X2210X	Orofacial Pain Dentistry	D8096	AZ

General Provider Information

NPI Number	:	1790040749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEENA PATEL DMD

Provider Business Mailing Address
First Line	:	10214 N TATUM BLVD STE A100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-4231
Country	:	US
Telephone Number	:	602-992-1486
Fax Number	:	602-992-6604

Provider Business Practice Location Address
First Line	:	10214 N TATUM BLVD STE A1100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-4243
Country	:	US
Telephone Number	:	602-992-1486
Fax Number	:

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

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	03/03/2026

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