Provider Demographics
NPI:1770245276
Name:PATADIYA, HIREN HANSRAJ (DMD)
Entity Type:Individual
Prefix:
First Name:HIREN
Middle Name:HANSRAJ
Last Name:PATADIYA
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 1:42 WELLMAN ST APT 330
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5168
Mailing Address - Country:US
Mailing Address - Phone:562-414-8991
Mailing Address - Fax:
Practice Address - Street 1:465 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3526
Practice Address - Country:US
Practice Address - Phone:978-689-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist