Provider Demographics
NPI:1326525148
Name:PATEL, PRIYANKA AMY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:AMY
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 1:470 WASHINGTON ST
Mailing Address - Street 2:STE 1
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-3566
Mailing Address - Fax:781-769-0992
Practice Address - Street 1:470 WASHINGTON ST
Practice Address - Street 2:STE 1
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-3566
Practice Address - Fax:781-769-0992
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18579761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110159561AMedicaid