Provider Demographics
NPI:1215167952
Name:PATEL, MITALI ((DMD))
Entity type:Individual
Prefix:
First Name:MITALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:(DMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:267-460-4254
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:8 PONDS EDGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9389
Practice Address - Country:US
Practice Address - Phone:610-388-9280
Practice Address - Fax:215-646-6199
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18552201223G0001X
PADS0394651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice