Provider Demographics
NPI:1033117676
Name:PATEL, JAYANTILAL L (DDS)
Entity Type:Individual
Prefix:
First Name:JAYANTILAL
Middle Name:L
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 1:767 5TH AVE
Mailing Address - Street 2:SUITE B-3A
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4207
Mailing Address - Country:US
Mailing Address - Phone:717-263-4462
Mailing Address - Fax:717-263-8014
Practice Address - Street 1:767 5TH AVE
Practice Address - Street 2:SUITE B-3A
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4207
Practice Address - Country:US
Practice Address - Phone:717-263-4462
Practice Address - Fax:717-263-8014
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020874L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000530061Medicaid