Provider Demographics
NPI:1356330898
Name:PATEL, KETANKUMAR B (DMD)
Entity Type:Individual
Prefix:DR
First Name:KETANKUMAR
Middle Name:B
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 1:3400 ARAMINGO AVE
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4531
Mailing Address - Country:US
Mailing Address - Phone:214-423-9060
Mailing Address - Fax:215-423-9087
Practice Address - Street 1:3400 ARAMINGO AVE
Practice Address - Street 2:SUITE A-4
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4531
Practice Address - Country:US
Practice Address - Phone:214-423-9060
Practice Address - Fax:215-423-9087
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS29960L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice