Provider Demographics
NPI:1861986911
Name:PATEL, JAY H (MS, DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:H
Last Name:PATEL
Suffix:
Gender:M
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1039
Mailing Address - Country:US
Mailing Address - Phone:215-595-7090
Mailing Address - Fax:
Practice Address - Street 1:10501 ACADEMY RD STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1137
Practice Address - Country:US
Practice Address - Phone:215-637-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0417181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice