Provider Demographics
NPI:1194803569
Name:PATEL, UDAYKUMAR P (DDS)
Entity type:Individual
Prefix:
First Name:UDAYKUMAR
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:UDAY
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:121 LAMPLIGHTER CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4713
Mailing Address - Country:US
Mailing Address - Phone:856-797-1161
Mailing Address - Fax:
Practice Address - Street 1:101 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-2304
Practice Address - Country:US
Practice Address - Phone:856-556-7466
Practice Address - Fax:856-556-9161
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI022604011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice