MEDICARE: DR. BHAVIKA PRAVIN PATEL D.D.S.

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	054104	NY

General Provider Information

NPI Number	:	1851538854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHAVIKA PRAVIN PATEL D.D.S.

Provider Business Mailing Address
First Line	:	291 E 3RD ST
Second Line	:	APT. 4B
City	:	NEW YORK
State	:	NY
Zip	:	10009-9703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 E 3RD ST
Second Line	:	APT. 4B
City	:	NEW YORK
State	:	NY
Zip	:	10009-9703
Country	:	US
Telephone Number	:	901-481-5165
Fax Number	:

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

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	01/13/2009

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