Provider Demographics
NPI:1316562366
Name:PATEL, KOMIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KOMIL
Middle Name:
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 1:12 JOHNSON PL
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1712
Mailing Address - Country:US
Mailing Address - Phone:862-237-1228
Mailing Address - Fax:
Practice Address - Street 1:1 SETH F TOBEY ROAD, BUILDING B
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:774-678-7051
Practice Address - Fax:774-687-7052
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18586551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice