Provider Demographics
NPI:1497177745
Name:PATEL FAMILY DENTAL
Entity Type:Organization
Organization Name:PATEL FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHREYAS
Authorized Official - Middle Name:INDRAVADAN
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-652-0777
Mailing Address - Street 1:8420 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1004
Mailing Address - Country:US
Mailing Address - Phone:315-652-0777
Mailing Address - Fax:315-652-0779
Practice Address - Street 1:8420 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1004
Practice Address - Country:US
Practice Address - Phone:315-652-0777
Practice Address - Fax:315-652-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0530481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty