Provider Demographics
NPI:1134106511
Name:PATEL, PARESH RAMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PARESH
Middle Name:RAMAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4818
Mailing Address - Country:US
Mailing Address - Phone:732-226-0568
Mailing Address - Fax:732-476-5244
Practice Address - Street 1:295 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2428
Practice Address - Country:US
Practice Address - Phone:732-226-0568
Practice Address - Fax:732-476-5244
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 213871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00043745Medicaid