Provider Demographics
NPI:1346261344
Name:PATHAK, TEJAL (DDS)
Entity Type:Individual
Prefix:
First Name:TEJAL
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:SUITE 2R
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2043
Mailing Address - Country:US
Mailing Address - Phone:973-328-1417
Mailing Address - Fax:973-366-2191
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 2R
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2043
Practice Address - Country:US
Practice Address - Phone:973-328-1417
Practice Address - Fax:973-366-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI202761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice