Provider Demographics
NPI:1154473783
Name:PATEL, JEMIN V (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEMIN
Middle Name:V
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 1:852 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-2611
Mailing Address - Country:US
Mailing Address - Phone:717-232-2237
Mailing Address - Fax:717-909-0640
Practice Address - Street 1:852 S 16TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-2611
Practice Address - Country:US
Practice Address - Phone:717-232-2237
Practice Address - Fax:717-909-0640
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015678820001Medicaid