MEDICARE: DR. PUJA 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	122300000X	Dentist	6571	NV

General Provider Information

NPI Number	:	1871854729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PUJA PATEL DMD

Provider Business Mailing Address
First Line	:	15 HAWTHORNE ST
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3018
Country	:	US
Telephone Number	:	908-370-3072
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 E FLAMINGO RD
Second Line	:	SUITE C
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	908-370-3072
Fax Number	:

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	04/01/2015

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