Provider Demographics
NPI:1225388846
Name:PATEL QI & BHANGRA DENTAL
Entity type:Organization
Organization Name:PATEL QI & BHANGRA DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-799-9991
Mailing Address - Street 1:7556 TEAGUE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1969
Mailing Address - Country:US
Mailing Address - Phone:410-799-9991
Mailing Address - Fax:410-799-3222
Practice Address - Street 1:7556 TEAGUE RD STE 104
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1969
Practice Address - Country:US
Practice Address - Phone:410-799-9991
Practice Address - Fax:410-799-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD137321223E0200X
MDMD133181223G0001X
MDMD137461223G0001X
MDMD136781223G0001X
MDMD149671223G0001X
MDMD137241223P0300X
MDMD133961223P0700X
MDMD143511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty