Provider Demographics
NPI:1730289208
Name:PATEL, PURAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PURAVI
Middle Name:
Last Name:PATEL
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 1:232 EAST MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-758-6162
Mailing Address - Fax:631-389-1014
Practice Address - Street 1:232 EAST MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-758-6162
Practice Address - Fax:631-389-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice