Provider Demographics
NPI:1215054648
Name:PATEL, SAMIR (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5930
Mailing Address - Country:US
Mailing Address - Phone:732-545-0001
Mailing Address - Fax:732-545-0004
Practice Address - Street 1:11 CLYDE RD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5035
Practice Address - Country:US
Practice Address - Phone:732-545-0001
Practice Address - Fax:732-545-0004
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023269001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice