Provider Demographics
NPI:1699407197
Name:PATEL, PRATEEK
Entity Type:Individual
Prefix:
First Name:PRATEEK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LANGLEY RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2394
Mailing Address - Country:US
Mailing Address - Phone:917-370-6984
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:2400 COMPUTER DR
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1887
Practice Address - Country:US
Practice Address - Phone:508-210-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130131223G0001X
390200000X
MADN1860021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program