Provider Demographics
NPI:1235510819
Name:HEMA PATEL DDS, LLC
Entity Type:Organization
Organization Name:HEMA PATEL DDS, LLC
Other - Org Name:WISTERIA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-515-0030
Mailing Address - Street 1:19729 EXECUTIVE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2642
Mailing Address - Country:US
Mailing Address - Phone:301-515-0030
Mailing Address - Fax:301-515-0031
Practice Address - Street 1:19729 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2642
Practice Address - Country:US
Practice Address - Phone:301-515-0030
Practice Address - Fax:301-515-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD078970400Medicaid