Provider Demographics
NPI:1437385614
Name:PATEL, PUSHPAK MAGANLAL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PUSHPAK
Middle Name:MAGANLAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OLD CART WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6364
Mailing Address - Country:US
Mailing Address - Phone:857-919-2273
Mailing Address - Fax:
Practice Address - Street 1:50 SALEM ST
Practice Address - Street 2:BLDG A, FIRST FLOOR
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2600
Practice Address - Country:US
Practice Address - Phone:781-334-3895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019632122300000X
MADN18551411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist