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NPI Code Detail

MEDICARE: VIDISHA N PATEL D.D.S

MEDICARE: VIDISHA N 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
11223G0001XGeneral Practice DentistryDS040062PA
21223P0221XPediatric Dentistry22DI02600900NJ
31223P0221XPediatric DentistryDS040062PA

General Provider Information

NPI Number : 1861835753
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIDISHA N PATEL D.D.S
Provider Business Mailing Address
First Line : 240 GEIGER RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1008
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 240 GEIGER RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1008
Country : US
Telephone Number : 215-677-0380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2013
Last Update Date : 07/05/2017

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