Provider Demographics
NPI:1063674232
Name:PATEL, JYOTI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
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 1:2303 REDTAIL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1873
Mailing Address - Country:US
Mailing Address - Phone:610-323-9030
Mailing Address - Fax:
Practice Address - Street 1:800 HERITAGE DR
Practice Address - Street 2:SIUTE 802
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9220
Practice Address - Country:US
Practice Address - Phone:610-323-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030591L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice