Provider Demographics
NPI:1215293196
Name:PATEL, MUKUNDKUMAR T
Entity type:Individual
Prefix:
First Name:MUKUNDKUMAR
Middle Name:T
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 OXFORD VALLEY RD STE 1801
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7725
Mailing Address - Country:US
Mailing Address - Phone:267-392-5878
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 1801
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7725
Practice Address - Country:US
Practice Address - Phone:267-392-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387991223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist